UK NSC stakeholder event 2017 Dr Sunil Bhanot screening inequalities presentation

1. Tackling inequalities in
screening
Dr Sunil Bhanot
Public Health England leads the NHS Screening Programmes

2. Health inequalities
2 Tackling inequalities in screening

3. Impact
3 Tackling inequalities in screening

4. Research evidence
4 Tackling inequalities in screening
Learning and
physical
disabilities
Economic and social
depravation
Ethnicity and cultural
barriers –
especially where
English a second
language
Hard to reach
groups
(travellers,
prisoners etc)
Unhealthy
behaviours

5. Screening inequalities
5 Tackling inequalities in screening

6. Overall coverage
for breast cancer
screening
• No learning
disabilities 68%
• With learning
disabilities 52%
Breast screening: age and learning disability
6 Tackling inequalities in screening
LD 78%
of non LD
LD 74%
of non LD
LD 77%
of non LDLD 80%
of non LD

7. Actions
7 Tackling inequalities in screening

8. Strategies to increase Breast cancer
screening uptake
• Postal reminders (Allgood et al, BJC 2016)
• RCT around 23,000 women
• Reminder or no reminder days before appointment
• 4% higher uptake (68% v 64%)
• Second timed appointments (Hudson et al, J Med Screen) 2016)
• Almost 3x as effective as open invites (20% uptake “v” 7.5%)
• Most effective where previous attendance
• GP endorsements
8 Tackling inequalities in screening

9. Uptake, informed consent and the risks of overdiagnosis
9 Tackling inequalities in screening