Module 4: Care

Female GP talking to patient in consult room

By completing Modules 2 and 3, you will have cleaned your cancer screening data and sent screening reminders to your patients.

Many of your patients will have responded to the reminders sent by your practice. But some patients will remain under-screened. The reasons why people don’t screen are often complex and include a range of social, cultural, individual and environmental factors. For example:

  • previous negative experiences
  • lack of transport
  • low health literacy
  • attitudes and beliefs that prevent participation. For example:
    • cancer is incurable and/or predetermined1
    • the false belief that certain cancers are not a risk for some communities (e.g. believing that people with a cervix who have not had sex with men are not at risk of cervical cancer)2
    • fear of cancer treatment
    • shame (including the belief that cancer is a result of behaviour in present or past lives)1

It is important to be aware that populations with lower levels of participation in cancer screening can experience higher cancer incidence and mortality.3,4,5  For example, the cervical cancer mortality rate for Aboriginal and Torres Strait Islander people is nearly four times that of non-Aboriginal and Torres Strait Islander people.6

It is important to take steps to improve participation in cancer screening among hard-to-reach groups.

Module 4 provides information on the following:

  • Who is at risk of not participating in cancer screening?
  • What barriers prevent participation in screening?

What can primary care do to overcome barriers to screening through the provision of high quality, patient-centred care?

Information and ideas for improvement

Information and ideas for improvement

Module 4 provides a lot of information and ideas for improvement. It is okay to pick just one or two ideas to start with. Remember, it’s best to commit to continuous small changes. Over time, lots of small changes can have a big impact.

Who is at increased risk of under-screening?

Unless otherwise referenced, the table below presents national screening data from the following Australian Institute of Health and Welfare reports:

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Community group

Bowel cancer screening participation
National average: 41%

Aboriginal or Torres Strait Islander: 21% 
Non- Aboriginal or Torres Strait Islander: 43.3% 

BreastScreen Australia participation 
National average5: 54.8%

ATSI: 39.1% 
Non-ATSI: 54.3%    

Cervical cancer screening participation 
National average7: 54.4–to56.4%

Cervical cancer: incidence is more than double and mortality is nearly four times higher.6 

Bowel cancer screening participation
National average: 41%

Those who speak languages other than English: 24.7–to34.1% 
Those who speak English at home:42.8–to46.4%.

BreastScreen Australia participation 
National average5: 54.8%

Those who speak languages other than English: 49.8% 

Cervical cancer screening participation 
National average7: 54.4–to56.4%

People from culturally and linguistically diverse backgrounds are less likely to participate in cervical screening.8

Bowel cancer screening participation
National average: 41%

People with disability: 36%
People without a disability: 43.2%

BreastScreen Australia participation 
National average5: 54.8%

Participation data is not available.

Cervical cancer screening participation 
National average7: 54.4–to56.4%

People with disabilities are less likely than the general population to attend cervical screening.9

Bowel cancer screening participation
National average: 41%

Data not available

BreastScreen Australia participation 
National average5: 54.8%

Participation data is not available but LGBTIQ+ people experience a unique clustering of risk factors for breast cancer.10

Cervical cancer screening participation 
National average7: 54.4–to56.4%

LGBTIQ+ people are less likely than the general population to attend cervical screening.2​

Bowel cancer screening participation
National average: 41%

People who live remotely: 27.5%
Those who live in major cities: 40.4%

BreastScreen Australia participation 
National average5: 54.8%

People who live remotely: 44.1% 
Those who live in outer regional areas:  56.9% 
Those who live in major cities: 53.3%

Cervical cancer screening participation 
National average7: 54.4–to56.4%

People who live remotely: 46.3%
Those who live in outer regional areas:  56.6%
Those who live in major cities: 56.4% 

Bowel cancer screening participation
National average: 41%

Men: 39% 

Bowel cancer screening participation
National average: 41%

Lowest SES group: 39%
Highest SES group: 43%

BreastScreen Australia participation 
National average5: 54.8%

SES makes limited difference to participation in BreastScreen Australia.

Cervical cancer screening participation 
National average7: 54.4–to56.4%

Lowest SES group: 50.4% 
Highest SES group: 62.1%

Bowel cancer screening participation
National average: 41%

The re-participation rate for those who had participated in their previous invite round and received a subsequent invitation was 78%.

BreastScreen Australia participation 
National average5: 54.8%

People who are recalled to assessment for further investigation and found not to have breast cancer are less likely to participate in subsequent screening rounds.

Cervical cancer screening participation 
National average7: 54.4–to56.4%

People who have experienced sexual assault or those that have undergone female genital cutting are less likely to participate in cervical screening.11