Raine Rosalind, Duffy Stephen W, Wardle Jane, Solmi Francesca, Morris Stephen, Howe Rosemary, Kralj-Hans Ines, Snowball Julia, Counsell Nicholas, Moss Sue, Hackshaw Allan, von Wagner Christian, Vart Gemma, McGregor Lesley M, Smith Samuel G, Halloran Stephen, Handley Graham, Logan Richard F, Rainbow Sandra, Smith Steve, Thomas Mary C, Atkin Wendy
Department of Applied Health Research, University College London, London WC1E 6BT, UK.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
Br J Cancer. 2016 Feb 2;114(3):321-6. doi: 10.1038/bjc.2015.413. Epub 2016 Jan 7.
There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual's general practice (GP endorsement; GPE) reduced this gradient.
A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation.
We enrolled 265,434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04-1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78,000).
Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP.
在英国国民健康服务体系的肠癌筛查计划（BCSP）中，筛查的接受情况存在社会经济梯度差异，这可能导致结果的不平等。我们测试了个体的全科医生对肠癌筛查的认可（全科医生认可；GPE）是否能减少这种梯度差异。
一项整群随机对照试验。在20天内，从6480家参与的全科诊所中，将符合英格兰筛查条件的个体随机分配，分别收到全科医生认可的邀请信或标准邀请信。主要结局是充分筛查的人群比例及其按多重剥夺指数五分位数的变化情况。
我们纳入了265,434名个体。干预组的接受率为58.2%，对照组为57.5%。在调整年龄、性别、中心和筛查轮次后，全科医生认可提高了总体接受率的几率（OR = 1.07，95%CI 1.04 - 1.10），但并未影响其社会经济梯度。我们估计，实施全科医生认可可能会多检测出多达165例高风险或中风险结直肠腺瘤和61例癌症，并且修改标准邀请信会产生一次性的小额成本（78,000英镑）。
虽然全科医生认可并未改善其社会经济梯度，但它为提高国民健康服务体系肠癌筛查计划中的总体筛查接受率提供了一种低成本方法。
