Jane Wardle from University College London gave a very important presentation at the 102^nd AACR meeting entitled ‘Socioeconomic Inequalities in Screening Participation’. Cancer screening is utilized less by individuals from lower socioeconomic status (SES) backgrounds than those from more privileged backgrounds. Organized screening programs with good call-recall systems provide more equality of access than opportunistic screening, but they don’t eradicate inequalities: In the first 2.6 million Faecal occult blood test (FOBT) kits mailed out in the National Health Service screening program in England, uptake was almost twice as high in affluent as in deprived areas. Research into the determinants of inequalities in screening is comparatively new. Qualitative studies in lower-SES groups tend to emphasize perceived barriers: time pressures, access, embarrassment, etc.

Quantitative studies have identified SES differences in perceived benefits, which may be due partly to lower health literacy in lower SES groups, but also a tendency to focus on short-term outcomes. Research is needed to discover how to communicate the advantages of screening effectively to populations with lower health literacy, more fatalistic attitudes, and a focus on coping with the here-and- now rather than the long term.

To this end the ASCEND Project a set of interventions to reduce the socioeconomic gradient in the uptake of the NHS Bowel Cancer Screening Programme. The project is part of the Cancer Communication and Screening group at the Cancer Research UK Health Behaviour Research Centre at University College London.

The aim of this project is to understand the factors (understanding, perceived benefits etc) involved in the social gradient in colorectal cancer screening. It is an interventional project and will focus mainly on enhancing written information materials contained within invitation letters and aims to refine the development and pre-testing of intervention materials.