Cancer screening – is everyone benefiting equally?

Women from some backgrounds may be less likely to go for screening

Cancer screening saves lives. Thousands of lives every year, in fact.

We know that it can help spot cancer earlier, when it’s more likely that treatment will be successful.  And cervical screening can actually help to prevent cancer from developing in the first place. But is everyone benefiting equally from the screening services we have?

A study published in the British Medical Journal this week says ‘no’.

In the past, we haven’t really had good information about the backgrounds of people going for screening, which meant that we didn’t know whether there were any inequalities in screening uptake. And since we didn’t know about them, we couldn’t do anything to try to reduce them.

So researchers from Oxford University, including Cancer Research UK’s Professor Valerie Beral, have piggybacked on a Government survey to ask more than 3,000 women about whether they had attended breast or cervical screening.

The researchers added questions on screening into the questionnaire over a nine month period, and then analysed the responses to see if there were any links between people’s backgrounds and whether they had gone for breast or cervical screening.

To build up a picture of people’s lives, the researchers looked at whether people had a car, how much education they had received, their occupation, whether they owned their own house or rented, which region they lived in, and their ethnicity.

What are the inequalities?

The researchers found that women who owned their own car and women who owned their own house (usually signs of wealth) were more likely to have had breast screening than women who didn’t.  But they found no evidence of a link between a woman’s ethnicity and her likelihood of going for breast screening.

The findings were slightly different for cervical screening.  The team found that women from Black and ethnic minority backgrounds were less likely to have been screened than white British women. But unlike breast screening, there seemed to be no link between their socio-economic status and whether or not they went for cervical screening.

We already had hints from smaller studies that these inequalities may exist. But this study adds more weight to the evidence, and calls for action from health professionals and policy-makers to tackle them.

So what’s going on here?

This study didn’t look into the reasons behind these associations, but its authors do speculate that owning a car may not just be an indicator of wealth. Going to breast screening often requires people to travel some distance to a clinic, hospital or mobile unit.

Conversely, cervical screening is usually done at the local GP’s surgery.  So women without cars in regions with poor public transport – such as rural areas – might find it difficult to go along for breast screening.

So the fact that women with a car are more likely to have had breast screening could simply be a sign that they are more mobile than women without a car. Even if this is true, though, it’s unlikely to account for the overall effect the researchers saw, and the fact that owning your own house was also related to screening uptake.  Clearly there are other social factors at work, which need more investigation.

Unfortunately, because there weren’t many women in the different ethnic minority groups, the researchers could only analyse the results for white British women and women of other ethnicity. This means that we don’t know about any individual ethnicities.

But if information like this was collected routinely, there would be many more people to base the analysis on, and patterns among different ethnic groups could be revealed. This is important, because there’s a fair amount of evidence that certain ethnic minorities are less likely to attend screening.

What can we do about it?

Encouragingly, the survey revealed that only 3 per cent of women had never had either form of screening, and 86 per cent of eligible women had gone for both types. But this study really shows that health professionals and policy-makers need to start collecting and sharing information like this routinely, so that they can begin to understand these inequalities better. And once they understand them, they can try to eliminate them.

Professor Julietta Patnick, the Director of the NHS Cancer Screening Programmes and one of the authors of the study, said:

“The challenge for the screening programmes is to make sure our services reach all parts of the population so we can reduce health inequalities.

“On the one hand we need to look at where mammography is available to make it easy for women to get to their appointments without having to travel too far; while with cervical screening, we need to ensure we’re providing information in an accessible way so all women can make informed decisions about whether or not to take up their invitation.”

We know that cancer screening saves lives. And everyone has the right to benefit equally from screening. The more we know about inequalities in screening, the more we can do to take well-informed steps to fix them, and studies like this are vital part of that effort.

Jess

Reference:

Moser, K., Patnick, J., & Beral, V. (2009). Inequalities in reported use of breast and cervical screening in Great Britain: analysis of cross sectional survey data BMJ, 338 (jun16 2) DOI: 10.1136/bmj.b2025

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