‘Not that one’: understanding why women screen for breast and cervical, but not bowel cancer

Abstract

BACKGROUND: Screening can reduce deaths from cervical, bowel and breast cancer if the people invited participate. Among women in Scotland, uptake of screening is 58% for bowel compared to 74% for breast and 71% for cervical screening. It is important to understand why bowel screening fails to achieve the uptake rates of breast and cervical screening. This study compared women’s responses to the NHS Scotland’s breast, cervical and bowel screening invitations, to better understand barriers to bowel screening. METHOD: We conducted individual interviews (n=60) with women aged 50 to 60 years who have participated in: i) all three screening programmes; ii) none, or iii) breast and cervical, but not bowel screening. Our purposive sample included women from areas of high and low deprivation. The data were analysed using Framework Analysis with reference to dual-process theory. FINDINGS: Overall, most participants had difficulty explaining their screening decision-making; screened women described immediate willingness to participate in response to screening invitations, whereas women who avoided bowel screening responded with disgust, and unscreened participants saw less value in screening. Perceived screening barriers of pain (breast), humiliation (cervical), and disgust (bowel) were common across all groups; the screened women, however, reported that perceived benefits outweighed these barriers. In contrast, women who avoided bowel screening experienced these barriers more strongly. DISCUSSION: Dual-process theory might help explain women’s responses to screening invitations as intuitive reactions. Perceived screening barriers appeared to be more strongly endorsed among those avoiding bowel screening. Addressing barriers in screening information may help improve participation.