By Marie Kotzur
April is bowel cancer awareness month. You may have noticed some posters to raise awareness or publicise events. Fittingly, I moved to Glasgow at the end of last April to work on a project to better understand Glaswegian women’s bowel cancer screening decisions.
The Scottish Bowel Screening Programme (SBSP) came to Glasgow in 2009. It is for people aged 50 to 74 years and involves taking stool samples at home. This article from the Dundee Cancer Centre has a nice summary of the SBSP and how it came to be.
In Scotland, 60% of eligible women do bowel screening, compared to 73% and 70% who attend for breast and cervical screening, respectively. Initially I thought the uptake might be lower, because the SBSP is new, and that, in time, participation would rise to match that in the other screening programmes. I had seen something similar happening when I was investigating cervical screening attendance in Ireland: participation started off low, but the programme has now become well established. Bowel screening, however, has been in Glasgow for 7 years now and participation has not risen in a similar way. Together with my colleagues at the University of Glasgow I want to find out more about this.
Why do some women avoid the bowel screening test, specifically?
What do the breast and cervical screening programmes do differently that might explain the higher participation rates?
To answer these questions, we invited women with different screening experiences for interviews. Some of them had taken part in all three screening programmes, and some had not done any cancer screening. A third group avoided bowel screening specifically, although they had done breast and cervical screening. We were most curious about this group. Women who are socio-economically disadvantaged are less likely to take part in cancer screening, so we made sure that we heard views from affluent and poorer women in each of the three screening groups.
Recruiting people for research interviews can be tough. We were expecting response rates of 5% at best, and we were not disappointed: it took us 6 months and 3200 invitation letters to recruit our participants. Every 3 to 4 weeks or so, my desk would be littered with piles 600 of envelopes to be labelled with return addresses (just in case), envelopes-with-return-addresses to be filled with study information sheets, reply letters and pre-franked reply envelopes, and filled envelopes waiting to be franked. On Franking Day I would await the 10am delivery of 600 franks which I needed to have stuck on my envelopes 2 hours later, in time for the lunchtime uplift when my precious envelopes would be carted off to our colleagues at the NHS Greater Glasgow and Clyde. They added the addressed invitation letters—I could not know whom we were actually inviting and would only know the names of those women who contacted me about the study.
Our participants lived all over the NHS Greater Glasgow and Clyde health board area and I can now find my way easily through Glasgow city, Paisley and Dumbarton, even Gourock—even though I have only lived here for barely a year! I have interviewed people in their homes, their workplaces, and in rented rooms in community centres. At one time I was struggling to find a room to interview a participant in her lunchbreak. A desk in the local library was too public, the function room in the community centre too big. Stuck with no roof over our heads I resorted to ringing local churches hoping for a parish hall with a smaller meeting room attached; and so it was that I interviewed my participant in the dining room of a parish house. I was even offered an overnight stay, which I declined, but it was quite a comfortable interview.
My next task is to compare the interviews to each other to find out what is common to the participants’ varied experiences of cancer screening and what the important differences are. Is there something about breast and cervical screening that we can apply to bowel screening to improve participation?
Watch this space, I will tell you soon!