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The ASCEND Study: Strategies to Reduce the Social Gradient in Bowel Cancer Screening

Funded by the National Institute for Health Research

March 2011 – February 2016

Key contact: Prof Rosalind Raine

Project team: Professor Rosalind Raine, Professor Jane Wardle, Dr Christian von Wagner, Professor Steve Morris, Dr Lesley Mcgregor, Dr Cecily Palmer, Dr Gemma Vart, Mr Sam Smith, Dr Allan Hackshaw (UCL); Professor Wendy Atkin (ICL), Professor Stephen Duffy (Barts and the London); Dr Stephen Halloran (BCSP Director Southern hub), Dr Graham Handley (BCSP Director North East hub), Professor Richard Logan (BCSP Director East of England hub), Dr Sandra Rainbow (BCSP Director London hub), Dr Stephen Smith (BCSP Director Midland and Northwest hub), Dr Neil Stubbs (BCSP Hub Manager South of England), Dr Austin Obichere (Director North Central London Bowel Cancer Screening Centre), Mr Patrick Fuller (User collaborator).

The ASCEND study seeks to reduce socio-economic inequalities in the uptake of bowel cancer screening. Bowel cancer is the second most common cause of cancer death in the UK. A strong evidence base underlies the implementation of population based screening in England, where five regional bowel cancer screening hubs co-ordinate screening for the NHS Bowel Cancer Screening Programme (NHS BCSP), offering the faecal occult blood test (FOBt) to adults aged 60-69, and currently being extended to 74 years. Screening uptake is 53%, but varies from 61% to 35% in the least to most deprived areas respectively. ASCEND study team members are based at UCL and Imperial College London, and are working in partnership with third sector organisations Age UK, Beating Bowel Cancer and ContinYou to devise and evaluate interventions to reduce the socio-economic gradient in uptake of bowel cancer screening.

The study comprises four work streams. The first explores the psychosocial and cultural determinants of low uptake of FOBt. Work stream 2 will develop and pilot three theoretically-based interventions designed to reduce the socio-economic gradient in bowel cancer screening. Of these interventions, one comprises an amended NHS BCSP invitation and reminder letter, while the other two are based on the provision of additional information which will supplement the existing bowel cancer screening information materials by presenting information in forms that are associated with increased salience and comprehension in lower socio-economic groups. Work stream 3 will undertake RCTs in defined areas to evaluate the effectiveness and cost effectiveness of each of the three interventions. Work steam 4 will develop a single complex intervention based on the previously trialled single interventions, and investigate its effectiveness and cost-effectiveness in a national RCT across England.