Understanding the barriers to bowel cancer screening in Latvia
Bowel cancer is the third most common type of cancer in Latvia, with over 1,000 new cases diagnosed annually. Unfortunately, the disease is often diagnosed at a late stage, making treatment more challenging and less effective.
In her bachelor’s thesis*, Gunda Jauntēva, who graduated from the Rīga Stradiņš University (RSU) Public Health bachelor’s programme, investigated the reasons why the target group in the Latvian population does not participate in screening programmes.
Bowel cancer is one of the most common cancers globally, with an alarmingly high incidence. According to the World Health Organisation, over 1.9 million cases of bowel cancer were reported worldwide in 2022, and more than 930,000 people died from the disease. Early screenings for bowel cancer, before symptoms appear, is crucial. This preventive measure can not only save lives but also result in significant healthcare savings.
Participating in bowel cancer screenings, or the faecal occult blood test, is simple: every two years, men and women aged 50 to 74 are invited to collect a test kit from their GP, complete the test at home, and return it to their GP. However, as it turns out, it’s not that simple.
In this paper, I analyse data from the 2022 Survey of Latvian Population Habits Affecting Health, conducted by the Centre for Disease Prevention and Control, selecting responses from 1,587 participants aged 50-74 years.
In Latvia, participation rates are alarmingly low, with fewer than 30%—or three out of ten people in this age group—taking advantage of the screening opportunity. This is below the European average.
Why is participation so low?
The 2022 Survey of Latvian Population Habits Affecting Health reveals several reasons why people choose not to undergo bowel cancer screening.
- The majority of respondents (59%) reported being insufficiently informed about the importance and benefits of screening. This lack of awareness is likely due to the fact that most respondents who did not undergo screening had not been advised or referred by their GP.
- Nearly half of the respondents (46%) cited feeling generally well, with no complaints, as the reason for not having the screening test, and therefore not considering it necessary. However, as mentioned earlier, bowel cancer can develop without pain or symptoms, and the screening programme targets individuals who may not have specific complaints to detect cancer in its early stages.
- Some respondents also mentioned that they found the test unpleasant or difficult, or simply did not want to undergo bowel cancer screening, without providing specific reasons. Information campaigns explaining the screening procedure could help reduce fears and dispel myths among those who are unresponsive.
How to improve participation?
To improve participation in the screening programme, it is essential to first explore the factors influencing people's decision not to participate in this publicly funded initiative by gathering public opinion on the screening process. While the Centre for Disease Prevention and Control survey allowed respondents to select from various reasons for not taking advantage of the screening, it did not provide a broader view, indicating the need for more in-depth research. Health professionals and policymakers must identify and target groups less likely to participate specifically, taking the existing attitude and information barriers into consideration when developing future screening programmes.
GPs should do more to encourage their patients to participate in screenings. Unlike uterine and breast cancer screenings, where letters are sent to target groups, bowel and prostate cancer screenings are organised by GP practices. The CDPC survey mentioned above also indicates that respondents who received specific recommendations or referrals from their GP were significantly more likely to participate than those who did not. This highlights the crucial role that doctors play in motivating and educating people about the risk of bowel cancer.
EUCanScreen: A joint step in the fight against cancer
A joint approach to improving cancer screening coverage will also be developed at the European level. A major project has just been launched, the Joint Action on the Bowel Cancer Screening Scheme (EUCanScreen), that aims to implement effective cancer prevention and early diagnosis across all European countries using standardised, evidence-based screening methods.
The project involves 25 EU Member States, along with organisations from Ukraine, Norway, Iceland, and Moldova. Its goal is to reduce inequalities in access to cancer diagnosis and treatment across Europe, enhance the quality and availability of screenings, and develop unified guidelines and training programmes for healthcare professionals.
The EUCanScreen project will enhance existing screening programmes for breast, cervical, and bowel cancer, while developing new schemes for the early detection of lung, prostate, and stomach cancers. The project involves over 97 partner organisations, including the Institute of Public Health at Rīga Stradiņš University.
Source: www.mammamuntetiem.lv
* 'Reasons for non-participation in bowel (colorectal) cancer screening among the 50-74 age group’
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