Data on screening for the following cancers are available from ISD Scotland:
- Bowel cancer - including Key Performance Indicators.
- Breast cancer - including UK National Health Service Breast Screening Programme (NHSBSP) Performance Standards.
- Cervical cancer.
- Abdominal aortic aneurysms (AAA) - published by ISD Scotland for the first time in March 2016.
Data on diabetic retinopathy screening uptake are available on the Scottish Diabetic Retinopathy Screening Collaborative website in the programme and performance reports.
Inequalities in uptake
A challenge for screening programmes is to ensure equality in uptake and linkage into care pathways among deprived and affluent populations. Data show that inequalities in screening uptake exist in Scotland.
- Consistently across NHS boards and Scotland as a whole a greater percentage of eligible women than men take up this screening (Scotland: 54.4% men vs 60.5% women (KPI 1)).
- Analysis by deprivation (Scottish Index of Multiple Deprivation (SIMD) 2012 quintile) reveals a clear deprivation gradient from greatest uptake of screening in the least deprived quintile to the lowest uptake in the most deprived quintile for both males and females across all NHS boards and Scotland as a whole (Scotland: 62.9% least deprived vs 43.0% most deprived quintile for men and 69.9% least deprived vs 47.1% most deprived quintile for women (KPI 2)).
Data are available by SIMD quintile for Scotland as a whole and shows a clear deprivation gradient from greatest uptake of screening in the least deprived SIMD quintile to the lowest uptake in the most deprived quintile throughout the period for which data are available, 1990-2012* (latest published 19th April 2016 for 1st April 2011 to 31st March 2012 (41Kb): 80.4% least deprived quintile vs 61.4% most deprived (SIMD2012)). (* note for 1990 to 2002 only women aged 50-64 years were invited for screening)
In 2011-12 the Scottish Breast Screening Programme was reviewed, which included a Health inequalities impact assessment (August 2012)(138Kb). The recommendations included actions to seek to reduce consequential health inequalities.
The Audit Scotland report Health inequalities in Scotland: Extent of health inequalities: detailed analysis (December 2012) (578Kb) highlighted the above inequalities in Scottish uptake of bowel and breast screening services and the Midlands and East Screening Equity Project 2012/13 included a literature review looking at the defined equality groups and barriers to screening services (March 2013). This literature review showed that groups defined by the protected characteristics of the Equality Act 2010 face additional barriers to uptake of screening services than do the general population, which can lead to inequalities.
Abdominal Aortic Aneurysms
Data published by ISD Scotland for uptake rates for eligible men for screening to 31st March 2015 (310Kb) shows that there was a gradient of uptake rate by deprivation area with uptake lowest in the most deprived areas: 90.4% in the least derived quintile compared to 77.4% in the most deprived quintile (SIMD2012).
Analysis of data from the Grampian AAA screening programme has also shown that uptake is high (89%) but that both urban-residence and social deprivation are independently associated with lower uptake Crilly et al (2015).
Analysis of data for the Diabetic retinopathy screening programme (DRS) has shown that uptake:
- Is lowest in the most deprived SIMD quintile increasing steadily across the quintiles to a high in the least deprived quintile.
- Falls from those aged 12 to 14 years to a low amongst those aged 25-34 years, rises to a high for those aged 65 to 74 years and thereafter drops off slightly.
- Varies across ethnic groups being lowest in those of Black African ethnicity* (source: personal communication Mike Black, Scottish DRS Collaborative Coordinator). (* note that ethnic groups are those defined by the software used and so are not to current Scottish definitions).
Other research has also shown that inequalities in screening uptake differ by screening type, for example:
Participation in the NHS cancer screening programmes seems to be lower for breast, cervical and colorectal cancer in ethnic minority groups (see Hoare, 1996; Webb et al, 2004; Moser et al, 2009; Weller et al, 2007; Robb et al, 2008 cited in Waller et al, 2009).
Colorectal cancer screening - Review of qualitative and quantitative studies published in English (the majority conducted in USA) by Javanparst et al (2010) found socio-economic status, ethnicity, age and gender to be predictors of test participation. Analysis of participation in London showed a strong socio-economic gradient in uptake and ethnic diversity also contributed to lower uptake (von Wagner et al, 2009).
Breast and cervical screening - have been adopted more in more affluent areas (see references in von Wagner et al, 2011). Analysis of survey data for Great Britain has shown that indicators of wealth are more important for breast screening uptake while ethnicity for cervical screening, uptake being lower for non-white females (Moser et al, 2009).
- Diabetic retinopathy screening programmes - analysis has highlighted that in areas with the greatest socioeconomic deprivation in Gloucestershire, diabetic prevalence is highest and attendance is poorest (Scanlon et al, 2008).
Abdominal aortic aneurysms screening – analysis for the Highland aneurysm screening programme in Scotland has shown a gradient of uptake associated with deprivation, despite levels being at almost 80% in the most deprived area (Ross et al, 2013). Similarly, analysis in Sweden has shown that uptake varies between different geographical areas and specifically men from low socio-economic status generally showed lower uptake (Zarrouk et al, 2013).
Overall, screening programmes in general have the potential to exacerbate existing inequalities in health outcomes. Measures to mitigate this have therefore been proposed, see below.
Interventions to reduce inequalities in screening uptake
A challenge for screening programmes is to find effective, simple and inexpensive population wide strategies to recruit individuals who find services hard to reach and those more likely not to take up screening opportunities, for example, those who live in areas of greater deprivation, in groups identified as harder to reach and covered by the Equality Act protected characteristics. Addressing the associated barriers is important, see for example: Jepson et al, 2000; HTA Project: 09/164/01; HS&DR Project: 12/64/112; Porter 2009 (647Kb).
NHS Health Scotland is in the process of producing evidence briefings on effective interventions to optimise uptake of breast, bowel and cervical screening programmes to reduce the associated inequalities in uptake.
Please note: If you require the most up-to-date data available, please check the data sources directly as new data may have been published since these data pages were last updated. Although we endeavour to ensure that the data pages are kept up-to-date, there may be a time lag between new data being published and the relevant ScotPHO web pages being updated.