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Breast and bowel cancer screening uptake patterns over 15 years for UK South Asian ethnic minority populations, corrected for differences in socio-demographic characteristics

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Szczepura, Ala, Price, Charlotte L and Gumber, Anil. (2008) Breast and bowel cancer screening uptake patterns over 15 years for UK South Asian ethnic minority populations, corrected for differences in socio-demographic characteristics. Biomed Central Public Health, Vol.8 . Article 346. ISSN 1471-2458

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Abstract

Abstract
Background
A number of studies have reported low uptake of cancer screening programmes by South
Asian populations in the UK. However, studies to date have not adjusted findings for
differences in demographics and socio-economic status of these populations.
Methods
Subjects: All residents in Coventry and Warwickshire, UK, eligible for screening.
Uptakes compared for round 1 (2000-02) and round 2 (2003-05) of a national bowel
cancer screening pilot, and for rounds 1, 2 and 5 of the established NHS breast cancer
screening programme (commenced 1989).
Data: Bowel screening data were analysed for 123,367 invitees in round 1 and 116,773
in round 2 (total 240,140 cases). Breast screening data were analysed for 61,934, 62,829
and 86,749 invitees in rounds 1, 2 and 5 respectively (total 211,512 cases).
Analysis: Screening uptake was compared for two broad meta-categories (South Asian
and non-Asian) and for five Asian subgroups (Hindu-Gujarati; Hindu-Other; Muslim;Sikh; South Asian Other). Univariate and multivariate analyses examined screening
uptake and various demographic attributes of invitees, including age, gender, deprivation
and ethnic group.
Results
South Asians demonstrated significantly lower (p<0.001) unadjusted bowel screening
uptake; 32.8% vs. 61.3% for non-Asians (round 1). Rates were particularly low for the
Muslim subgroup: 26.1% (round 1), 21.5% (round 2). For breast screening, a smaller
difference was observed between South Asians and non-Asians; initially 60.8% vs.
75.4% (round 1) and later 66.8% vs. 77.7% (round 5). Thus, the disparity reduced
gradually over time, alongside an overall trend of increased uptake. However, figures
remained consistently low for Muslims (51% in rounds 1 and 5). After adjusting for age,
deprivation (and gender), bowel screening uptakes remained significantly lower for all
South Asian subgroups. After similar adjustments, breast screening uptake remained
lower for all subgroups except Hindu-Gujaratis.
For Muslims registered with an Asian (vs. non-Asian) GP, bowel screening uptake was
significantly lower (p<0.001). However, breast screening uptake for Muslims with an
Asian (vs. non-Asian) GP showed no difference (p=0.12) in the same period. Colonoscopy and breast assessment uptakes were similar for both meta-categories, but
Asian response time appeared slower for colonoscopy. The percentage of abnormal
FOBT results was significantly higher for South Asian invitees. A slight increase in
abnormal mammograms was observed for Muslims over time (2.7% to 4.2% in rounds 1
and 5 respectively).
Conclusions
The lower cancer screening uptakes observed for the South Asian population cannot be
attributed to socio-economic, age or gender population differences. Although breast
screening disparities have reduced over time, significant differences remain. We conclude that both programmes need to implement and assess interventions to reduce
such differences.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Minorities -- Medical care -- Great Britain, Medical screening -- Great Britain, Breast -- Cancer -- Diagnosis, Intestines -- Cancer -- Diagnosis
Journal or Publication Title: Biomed Central Public Health
Publisher: BioMed Central Ltd
ISSN: 1471-2458
Official Date: 2 October 2008
Volume: Vol.8
Page Range: Article 346
Identification Number: 10.1186/1471-2458-8-346
Status: Peer Reviewed
Access rights to Published version: Open Access
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URI: http://wrap.warwick.ac.uk/id/eprint/237

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