By Sophie Mulcahy Symmons
We’ve published new research which provides some understanding about the factors that influence the participation in cancer screening across subgroups of people. The research was done to support our work to reduce inequities and barriers to accessing screening and enable more people to make informed choices about attending screening.
Why we did the research
Participation in Ireland’s bowel, breast and cervical cancer screening programmes is not consistent across different groups of people. We wanted to find out if there are differences in cancer incidence and participation in screening determined by people’s backgrounds and lifestyle.
How we did it
We reviewed evidence that collected or reported on factors related to the social determinants of health: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socio-economic position, social capital, and other characteristics including age, sexual orientation, disability, behaviours and relationships. We reviewed academic research from online sources, and reports from non-governmental organisations, National Cancer Registry Ireland, and the Central Statistics Office.
What we found
Sex, age, place of residence and socio-economic position were the most commonly captured factors that influenced incidence of cancer and participation in screening. Religion, disability, and sexual orientation were rarely captured.
- Bowel screening: Participation in bowel screening was lower for men, for those of lower socio-economic position and among the Irish Traveller community. Participation in screening varied across counties. Being employed or unemployed did not appear to influence participation.
- Bowel cancer: Bowel cancer incidence was higher for men, for people living in urban areas and for those of lower socio-economic position.
- Breast screening: Participation in breast screening varied across counties. Lower participation in breast screening was apparent among people who were unemployed, who were members of the Irish Traveller community, in people with a disability, people with low education levels and among those of lower socio-economic position. Participation was higher among those with private health insurance and medical cards, people who are married and those aged over 55.
- Breast cancer: Breast cancer incidence was higher for people living in urban areas, for those of higher socio-economic position and in people aged 60 to 64.
- Cervical screening: Participation in cervical screening was lower for people with low levels of education, for those of lower socio-economic position, among people aged over 50, of Irish nationality, and among those who identify as LGBT+. Participation in cervical screening varied across counties and was higher for people with private health insurance.
- Cervical cancer: Cervical cancer incidence was higher for people living in urban areas, for those of lower socio-economic position and in people aged 45 to 49.
What this tells us
This research was important to draw together existing evidence about who takes part in cancer screening and begin to understand why some people might not attend screening. The review shows there are wide variations of cancer incidence and participation in screening. Due to the limited use of factors and variations in research methods used, it is difficult to determine who is and is not participating in screening. There was only strong evidence to show people of lower socio-economic groups most often have higher incidence and lower participation in screening for breast, cervical and bowel cancer, bar breast screening which had higher incidence among higher socio-economic groups.
What we can do
More research is needed to develop a more detailed picture of who does and does not participate in screening in Ireland. We are working to improve the collection of data on screening participation.
Working with communities who are less likely to take part in screening is key to understanding what barriers people experience accessing screening and how they could be meaningfully supported to attend for screening.
Sophie Mulcahy Symmons is a PhD Scholar at the School of Nursing, Midwifery and Health Systems, University College Dublin and worked on the research during her placement at the National Screening Service in 2022.
‘How is equity captured for colorectal, breast and cervical cancer incidence and screening in the Republic of Ireland: A review’ is published in Preventive Medicine Reports.
This review has been used to inform the development of our strategic framework to improve equity in screening, due to be published by the end of 2023.