Do cancer screening programs increase the health gap between the well-to-do and the not-so-well-off?
That is one worrying implication from a study just published in the Medical Journal of Australia.
Researchers sought to examine the initial impact of the national bowel cancer screening program which offers faecal occult blood testing to those aged 55 or 65.
They reviewed the data on bowel cancers diagnosed between May 2006, when the program began, and June 2008 from a database involving 19 hospitals. The good news is that cancers detected through screening tended to be at an earlier stage than those diagnosed as a result of patients presenting for testing because of symptoms.
The worrying news for anyone concerned about equity is that almost two-thirds of the patients whose cancers were detected through screening were from wealthier backgrounds. Somehow, I don’t think this means that wealthier people are at increased risk of developing the cancer; it is much more likely to mean that the poorer groups are less likely to access screening.
Professor Ian Olver, ceo of Cancer Council Australia, has filed this analysis of the study:
“The recent report on the impact of bowel screening in Australia by analysing patients who present for surgery for colorectal cancer confirms the ability of the program to save lives.
As with studies from other countries, patients who are screened present with earlier stage disease which is more likely to be cured.
The study showed a disparity between low and high socioeconomic groups. Those from lower socioeconomic groups are less likely to have been screened.
Whilst this has been reported from other studies, potential solutions are not as well researched. It is known that certain subgroups like the culturally and linguistically diverse communities and Aboriginal communities will need culturally appropriate translations of information about screening. The access of remote populations may be an issue.
However what of the majority of people in lower socioeconomic groups? A recent American study has shown that educational level is a key factor, because it influences the provision of information about screening by healthcare providers (Ye J et al Cancer Epidemiol Aug 28 epub before press).
Clearly GP’s and other providers have an important role in encouraging participation in screening.
However, the major issue remains that given the proven ability of a bowel screening program to save lives, Australia still only has a one off bowel testing program rather than a full screening program.
There is no rescreening, which should occur every 2 years, and bowel screening kits are only mailed to 50, 55 and 65 year olds. Too many Australians, of all socioeconomic groups, are missing out on a program that could save 30 lives each week if fully implemented. It is urgent that the Government completes the role-out of bowel screening.”
The other worrying note from the study is the authors’ comment about the lack of evaluation of the screening program. They wrote:”…no resources have been allocated to determine the program’s ultimate impact on bowel cancer incidence or mortality”.
If true, this seems a remarkable oversight – to roll out a national program without having in place a proper evaluation process. Is this really the case?