ObjectiveThis study tested methods to increase lung cancer screening referral/order and completion rates in primary care.MethodsPatients identified via the electronic medical record as potentially lung cancer screening eligible were randomized either to a telephone outreach and decision counseling Group (N = 506) or a usual care Group (N = 2066). We evaluated intervention and covariate effects overall and assessed outcomes among telephone outreach and decision counseling Group patients verified as eligible (n = 55), comparing rates of those who had decision counseling (OC + DC Group, n = 24) and who did not (OC-DC Group, n = 31).ResultsTelephone outreach and decision counseling Group lung cancer screening referral/order and completion rates were higher than usual care Group rates (16% and 9%, respectively, OR = 1.82, CI: 1.37, 2.41) and (8% and 6%, respectively, OR = 1.45, CI: 0.999, 2.09) and rates were higher among older and currently smoking patients (OR = 1.18, CI: 0.999, 1.40 and OR = 3.09, CI: 2.36, 4.05, respectively and OR = 1.32, CI: 1.06, 1.65 and OR = 2.78, CI: 1.98, 3.92, respectively). Among eligible patients, the lung cancer screening referral/order rate was much higher in the OC + DC Group versus OC-DC Group (96% and 42%, respectively, RR = 2.28, CI: 1.50, 3.49) and the lung cancer screening completion rate was somewhat higher (46% and 36%, respectively, RR = 1.29, CI: 0.68, 2.46).ConclusionFindings suggest that patient outreach and decision counseling may increase lung cancer screening rates in primary care.
BackgroundEmployees often remain underserved in healthcare due to demanding work schedules, limited access to services, and socioeconomic constraints. Risk-prone lifestyles further increase their vulnerability to oral potentially malignant disorders (OPMD) and oral cancer. Workplace-based screening represents a feasible and risk-based strategy for early detection and prevention. This review evaluated workplace-based OPMD screening by estimating prevalence and examining its role in early diagnosis and prevention of oral cancer.MethodsThe protocol was registered in PROSPERO (CRD42024574036). Comprehensive searches across major databases were performed using predefined eligibility criteria. Data were extracted after de-duplication. Study quality and risk of bias were assessed using Joanna Briggs Institute (JBI), Cochrane Risk of Bias in Non-Randomized studies of Exposure, and GRADEpro. A random-effects meta-analysis estimated pooled prevalence and associated risk factors.ResultsNineteen studies (1988-2024), predominantly cross-sectional, identified 4480 OPMDs among 30,358 screened workers, yielding a pooled prevalence of 17% (95% CI: 0.12-0.23) with substantial heterogeneity (I2 = 99.3%). The pooled point estimates were above 1 for tobacco users and males; however, the 95% confidence intervals included 1, indicating that these associations were not statistically significant. The estimate for age was close to 1 and was also not statistically significant. Most studies showed low (n = 8) to moderate (n = 9) methodological quality (JBI) and low to very low certainty of evidence (Grading of Recommendations, Assessment, Development, and Evaluations), with marked publication bias.ConclusionNearly one-fifth of workers had an OPMD, with risks amplified by tobacco, age, and gender. Periodic workplace screening, awareness activities, intersectoral coordination, and a common risk factor approach are essential to strengthen oral cancer prevention.
BackgroundAlmost all national guidelines groups recommend that individual men make an informed personal decision about whether to be screened for prostate cancer. This implies the decision to undergo prostate-specific antigen (PSA) testing is preference sensitive; that is, whether the expected utility of screening is higher or lower than that of no screening can vary depending on a man's preferences ("utilities") for downstream health states such as urinary incontinence.MethodsWe reviewed the literature to find evidence on whether PSA screening is indeed a preference-sensitive decision.ResultsWe found that preference sensitivity was routinely asserted without providing any evidence. Some authors pointed to studies of PSA decision aids, but there is no logical link between a decision aid changing a decision and that decision being preference sensitive. The major modeling study on PSA screening found higher expected utility for PSA screening irrespective of how a man might feel about the side-effects of treatment. One study did find that while PSA screening was generally favored, expected utility was fractionally lower in a small subgroup, but the difference was extremely small, and would not be negative with recent changes to PSA screening pathways.ConclusionThe assumption underlying informed choice policies-PSA screening is a preference-sensitive decision-is not supported by the literature. Men should be provided with clear information about and give consent for PSA testing, but preference elicitation as part of shared decision-making is not indicated.
ObjectivesTo examine how cancer screening programs resumed during the COVID-19 pandemic, focusing on their resilience in terms of coordination, communication, recovery, participation rates, catch-up efforts, inequities, and preparedness.SettingCancer screening programs represented in the International Cancer Screening Network.MethodsFour cancer-specific questionnaires were developed, piloted, and distributed via SurveyMonkey to purposively selected program managers between February and July 2022. Responses from 79 programs (37% response rate) were aggregated by cancer type and screening delivery mode. Descriptive analyses summarized coordination/prioritization, operational capacity, participation/follow-up rates, communication, catch-up, inequities, and preparedness. Comparisons were made across cancer types and screening delivery, and open comments and shared documents provided contextual insights.ResultsMost programs (52%) were organized and resumed driven primarily by government decisions (57%). Nearly all organized programs resumed by July 2020, with faster recovery to full capacity compared to non-organized settings. Most programs had to adapt their screening services (75%) focusing on infection control, and breast and lung programs recovered capacity quicker than cervical and colorectal. Reduction in participation rates varied by cancer type and organization, and colorectal programs reported less impact. Debriefs (40%) and publication of the data (31%) were the most common preparedness actions, while 21% of the programs reported no preparations.ConclusionsCancer screening programs demonstrated moderate absorptive and adaptive capacity with organized programs resuming faster but experiencing higher reduction in participation rates compared to non-organized screening. Findings highlight the need to integrate resilience and preparedness into the development and management of screening programs to mitigate future disruptions.
BackgroundScreening mammography reduces breast cancer mortality, yet adherence varies across populations even in welfare-based healthcare systems. Israel provides universal coverage and organized outreach, but disparities in utilization persist.ObjectiveTo assess adherence to national mammography screening guidelines among Israeli women and identify sociodemographic and clinical factors associated with screening behavior.MethodsWe conducted a retrospective cohort study using Clalit Health Services' central database. A random sample of 95,603 eligible women aged 45-75 years was followed from 2006 to 2020. Adherence was calculated monthly using 24-month screening intervals and categorized as poor (<0.2), low (0.2-<0.5), moderate (0.5-<0.8), or full (≥0.8). Associations with sociodemographic, clinical, and preventive health behaviors were examined.ResultsAdherence was poor in 26.6%, low in 26.9%, moderate in 28.2%, and full in 18.3% of participants. Higher adherence was associated with younger entry age, central residence, and Arab versus ultra-Orthodox affiliation, whereas lower adherence correlated with peripheral residence and higher religiosity. Obesity, diabetes, hypertension, depression, and dementia were more prevalent among poorly adherent women. Engagement in other preventive services (Pap smear, influenza and pneumococcal vaccination, colorectal screening) clustered with mammography adherence. Mortality was lower in the full adherence group (3.8%) than in the poor adherence group (43.2%; p < 0.0001).ConclusionsDespite universal coverage, substantial disparities in mammography adherence persist. Screening behavior reflects sociodemographic, cultural, and clinical determinants, and clusters with other preventive health practices, highlighting opportunities for targeted interventions.
ObjectiveTo provide descriptive analysis of observational data on breast screening uptake and coverage in North East London with a focus on health inequalities.SettingAreas in North East London with amongst the lowest breast screening uptake, coverage and breast cancer survival in England.MethodsWe investigated screening uptake and coverage for 163 general practices (GPs) served by the NHS Central & East London Breast Screening Service retrieved from Public Health England's Fingertips resource. The 10 highest and 10 lowest GPs by uptake and by coverage were identified. We summarised pre-treatment T-stage (tumour size) over time and by age group.ResultsOverall, uptake and coverage were lowest in City & Hackney, Newham and Tower Hamlets, with uptake of 7-26%, 13-26% and 24-28% respectively. GPs with the highest uptake and coverage rates tended to be in Waltham Forest (uptake 56-65%). The maximum uptake observed in 2022 was 72%, above the national uptake target of 70%, for one practice.For women receiving a breast cancer diagnosis, the proportion of larger-sized tumours seemed to increase during the 2020-2021 Covid-19 pandemic period (implying later diagnoses), eventually returning to pre-pandemic levels. Smaller tumours were identified at the screening ages 50-70 (<20% T3/T4, implying earlier diagnoses) compared to younger (∼25% T3/T4) and older (∼30% T3/T4) women.ConclusionsBreast screening uptake varied between areas and GPs. City & Hackney, Tower Hamlets and Newham were identified as areas with low screening uptake and coverage.
ObjectiveThis review assessed the diagnostic accuracy of urine self-sampling for human papillomavirus (HPV) detection compared with clinician-collected cervical and vaginal samples.MethodsA systematic search of PubMed, and Embase (January 2013-October 2023) identified full-text English studies evaluating urine-based HPV testing conducted in clinical settings and compared with provider-collected samples. Data were extracted using a standardised form, with sensitivity and specificity as primary outcomes. Risk of bias was assessed using QUADAS-2 and QUADAS-C tools. The review followed PRISMA-P guidelines and was registered in PROSPERO (CRD42024511154). A random-effects meta-analysis summarised diagnostic accuracy.ResultsOf 1657 citations, 13 studies met the inclusion criteria. Urine sampling showed lower sensitivity for detecting high-risk HPV and high-risk HPV-associated high-grade squamous intraepithelial lesions (HSIL) than vaginal samples, although specificities were comparable (87% for urine vs. 88% for vaginal samples). Sensitivity for detecting high-risk HPV-HSIL was 75% for urine, compared with 92% for vaginal and 95% for cervical samples. Cervical samples demonstrated the highest diagnostic accuracy, followed by vaginal samples, while urine samples performed the lowest on the summary receiver operating characteristic (ROC) curve.ConclusionUrine self-sampling is a non-invasive and acceptable option but demonstrates reduced sensitivity compared with vaginal and cervical sampling. Despite lower accuracy, its convenience may support screening among women who might otherwise not participate.
ObjectivesTo evaluate the economic benefits of implementing an organized community-based screening program for oral, breast, and cervical cancers in rural Bangladesh.MethodsA cost-benefit analysis was conducted over a one-year time horizon, with program costs estimated from the provider perspective and economic benefits assessed from the household perspective. Screening costs were estimated using primary data from a 2024 pilot implementation and extrapolated to all rural areas nationally. Economic benefits were defined as savings from averting late-stage cancer through early detection and included avoided direct medical and non-medical costs, income loss of patients and caregivers, and intangible benefits related to pain and distress. Benefit estimates were derived from a facility-based survey of 346 patients with oral, breast, or cervical cancer and extrapolated to the rural population using an incidence-based approach. Parameter uncertainty was assessed using one-way and probabilistic sensitivity analyses.ResultsThe total annual cost of implementing the screening program in rural Bangladesh was estimated at US$69.02 million. Total annual economic benefits were estimated at US$106.77 million, yielding net benefits of US$37.76 million and a benefit-cost ratio of 1.55. Probabilistic sensitivity analysis indicated a high likelihood of cost-benefit, with 98.9% of simulations exceeding unity.ConclusionsAn organized community-based screening program for oral, breast, and cervical cancers in rural Bangladesh is economically favorable and robust to uncertainty, even under conservative benefit assumptions. The findings support a transition from opportunistic to organized screening in Bangladesh, and provide policy-relevant evidence for cancer control planning in other resource-constrained settings.
Fecal immunochemical testing (FIT) screens for colorectal cancer (CRC) through detection of hemoglobin. Specimens without a collection date are a common source of test cancellation. We implemented a quality improvement intervention to improve collection date documentation and screening completion using a pre-post design. Within a large US Veterans Affairs (VA) CRC screening trial, we modified the FIT return envelope instructions, including a field for collection date documentation on the envelope. Preintervention 6654/7083 FIT kits (93.9%) were received with a collection date compared to 3069/3105 (98.8%) postintervention (p < .00001). Preintervention, 35.2% of kits without a date were received within 15 days of original outbound mailing of the kit from VA, thereby allowing testing in 95.4% of all kits received. Postintervention, 44.4% of undated kits were received within 15 days of mailing from the VA, allowing for testing of 98.8% of all kits (p < .00001 compared to preintervention). The intervention was associated with an absolute 3.5% (95% CI: 2.8%-4.1%) increase in testable kits, thereby reducing the proportion of individuals requiring retesting from 4.6% to 1.2%. This no-cost, targeted intervention was associated with a significantly increased proportion of individuals successfully completing screening. Programs using FIT should consider implementation of this no-cost intervention to enhance program effectiveness.
ObjectivesGiven steady increases in age-standardized colorectal cancer incidence, health authorities in Mexico could consider implementing a colorectal cancer screening program. To inform program design, we evaluated the cost-effectiveness of fecal immunochemical testing (FIT) among a hypothetical cohort of 45-year-old residents of Mexico City. We adapted a validated US microsimulation model of colorectal cancer to reflect epidemiological outcomes in Mexico City.MethodsUsing the adapted model, we estimated the lifetime health outcomes and costs associated with no screening and with FIT strategies that varied by the start age, end age, screening interval, and hemoglobin threshold for colonoscopy referral. We obtained costs from published reports and formularies. We calculated incremental cost-effectiveness ratios and identified the cost-effective FIT strategy as the strategy with the highest ratio below the willingness-to-pay threshold of 381,000 MXN per quality-adjusted life-year (QALY) gained (i.e., three times Mexico's per-capita Gross Domestic Product).ResultsCompared with no screening, the effectiveness of FIT screening ranged from 23 to 49 QALYs gained per 1000 45-year-olds. Biennial FIT from age 50 to 70 with the most lenient threshold for colonoscopy referral (10 μg of hemoglobin/g of feces) was the cost-effective strategy. The starting age of screening was sensitive to assumptions about the cost of unreturned test kits, outreach costs, and colorectal cancer risk.ConclusionsScreening for colorectal cancer with FIT may be cost-effective in Mexico City. Additional studies are needed to assess whether the colonoscopy capacity is sufficient to support a lenient referral threshold.
ObjectivesVisual colonoscopy is a standard method for colorectal cancer screening but carries unnecessary operative risks. This study aimed to develop a clinical prediction model to identify patients at high risk of colorectal polyps or benign conditions detectable via colonoscopy.SettingData were routinely collected during mass screenings: December 2022 at Kumpawapi Hospital, January 2023 at Nhonghan Hospital, and April 2024 at Wangsammo Hospital. All participants with positive fecal immunochemical tests were included.MethodsA retrospective delayed-type cross-sectional study was conducted. Predictors included male sex, age, family history of colorectal cancer, prior colonoscopy, smoking, alcohol use, diabetes, clinical symptoms (e.g. altered bowel habits, weight loss, decreased stool caliber), and hematocrit level. Polyps were biopsied and histologically examined. A clinical prediction model was derived using multinomial logistic regression, selecting predictors based on clinical relevance and face validity. Patients were classified into three risk groups (normal, benign, malignant). Model absolute accuracy was assessed by comparing predicted versus actual classes. Polytomous discrimination index (PDI) was evaluated.ResultsAmong 1071 patients undergoing colonoscopy, 66 (20.3%) had benign polyps, 148 (45.4%) had non-advanced adenomas, 103 (31.6%) had advanced adenomas, and 9 (2.7%) had colorectal cancer. Final predictors were male sex, age (year), family history of colorectal cancer, alcohol use, and abdominal pain. The model showed an absolute accuracy of 0.484 (95% CI, 0.454-0.513) and a PDI of 0.426 (95% CI, 0.396-0.456).ConclusionsThe model showed fair discrimination in identifying high-risk patients. This prediction rule may support shared decision-making for elective colonoscopy and help prioritize patients for urgent screening.
IntroductionBreast density is a risk factor for breast cancer and reduces the sensitivity of mammography. Manual breast imaging reporting and data system (BI-RADS) classification remains the clinical standard, but automated methods have been developed to improve reproducibility and efficiency. This review evaluated the concordance between automated/semi-automated measurements and manual assessments of mammographic breast density.MethodsWe systematically searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus, and Web of Science (2014 onwards) for studies comparing automated or semi-automated measurement with manual BI-RADS classification on 2D digital mammography. Eligible studies included ≥60% of participants from routine screening populations. Data extraction and risk of bias assessment followed a registered protocol (PROSPERO: CRD42024550250).ResultsThere is good concordance between automated/semi-automated measurement and manual assessment of breast density in the 26 included studies. Meta-analysis of 13 Volpara studies showed a tendency to classify mammograms as dense compared with manual assessment, but the difference was not statistically significant and statistical heterogeneity was very high (pooled difference 0.03, 95% CI -0.03 to 0.10; I2 = 98%). Studies of Quantra and other software showed broadly similar findings, but variability in software versions and BI-RADS editions limited comparability. Reporting of participant demographics was poor, thus generalisability is unclear.ConclusionsAutomated breast density software, such as Volpara and Quantra, shows promising concordance with manual BI-RADS assessment and may enhance consistency in screening programmes. Heterogeneity across studies and limited information on representativeness preclude firm conclusions. Large-scale, standardised, and inclusive evaluations are needed to establish clinical utility.FundingNational Institute for Health and Care Research.
ObjectiveCervical cancer screening reduces incidence and mortality dependent on participation. To increase participation we investigated the best time to send repeated invitation (RI) letters to those who did not attend screening after the first letter.MethodsWe designed a prospective population-based cohort study featuring 3,352,211 first invitation letters and 2,449,187 RI letters sent between 2012-01-01 and 2023-12-31 to all Swedish screening-eligible women aged 23 to 70. We measured participation rates based on the time between invitation letters and their first RIs, adjusted for age, calendar month/year, screening test (HPV/cytology), and healthcare region.ResultsThe strongest RI-to-participation association was observed for RIs sent 8-12 weeks after the invitation letter, with 65% participation and adjusted odds ratio (aOR) 1.42 (1.34-1.50). This was consistent for women below 50, aOR 1.35 (1.28-1.44) / 64% participation; and women above 50, aOR 1.95 (1.63-2.32) / 72% participation. Participation declined with number of RIs sent, with the first RI followed by 49% participation and the seventh followed by 21% participation. Only 10.9% of the screening population required a fourth RI or more.ConclusionSending a RI 8-12 weeks after the original invitation was associated with the highest participation. After sending four RIs other methods of communication should be employed to encourage screening participation.
ObjectivesCervical cancer screening programs reduce cervical cancer mortality; however, screening engagement is not equally distributed across populations, and evidence on factors contributing to variation remains limited.MethodsUsing data from the Canadian Partnership for Tomorrow's Health (CanPath) across five regional cohorts (BC Generations Project, Alberta's Tomorrow Project, Ontario Health Study, CARTaGENE, and Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH), we assessed self-reported engagement in Pap test cervical cancer screening among participants recruited between 2008 and 2016. Self-reported Pap (Papanicolaou) screening status was categorized as "never" or "ever." Ever screening was further classified as "recent" (≤3 years) or "past" (>3 years). Multivariable logistic regression models assessed associations with screening status while adjusting for potential confounders.ResultsA total of 166,804 individuals met the inclusion criteria. Across cohorts, 162,592 (97.5%) and 4212 (2.5%) reported ever and never undergoing cervical cancer screening, respectively. Among those with a screening history, 135,823 (83.5%) were recently screened, ranging from 78% in CARTaGENE to 85% in Atlantic PATH. Nonwhite ethnicity, lower household income, single or never-married status, low physical activity, poorer self-perceived health, and ≥24 months since the last medical checkup were associated with never or past screening. Current smoking, younger age, and reproductive and hormonal factors showed differential associations between never versus ever screened individuals and past versus recent screening.ConclusionThe national target of 80% cervical cancer screening adherence was exceeded in most regions. Persistent socioeconomic and health-related disparities highlight the need for targeted interventions. Differences between factors associated with screening initiation and maintenance warrant further investigation.
ObjectiveTo investigate the real-world impact of organised mammography screening on breast cancer mortality in metropolitan areas with widespread opportunistic imaging.MethodsWe conducted a population-based incidence-density case-control study among women aged 50-74 years resident in Milan, Italy. We matched 900 breast cancer deaths (diagnosed 2008-2022; died 2012-2023) to 3600 controls by age (±3 months), postcode and citizenship. Individual screening histories were reconstructed by deterministic linkage across five administrative databases. Conditional logistic regression estimated odds ratios (ORs) for breast cancer death by invitation and participation. Opportunistic mammography was modelled, and self-selection bias was corrected using a factor of 1.28.ResultsInvitation was associated with lower mortality (adjusted OR 0.71, 95% CI 0.58-0.85). Participation in at least one programme screen yielded an adjusted OR of 0.44 (0.36-0.52), which attenuated to 0.64 (0.53-0.77) after self-selection correction. Adjustment for opportunistic mammography had minimal impact on programme estimates.ConclusionsIn a large metropolitan setting characterised by intensive opportunistic imaging, organised screening confers a significant mortality reduction, chiefly among participants. Policies discouraging opportunistic substitution and enhancing adherence may increase population benefit.
Prostate cancer is the most commonly diagnosed cancer in UK men excluding non-melanoma skin cancer, with over 64,000 new cases and 12,000 deaths annually. This disparity between incidence and mortality has fuelled debate about over-diagnosis and the value of screening. The UK National Screening Committee has advised against population prostate-specific antigen (PSA) screening, citing uncertainty regarding benefit and harm. However, a risk-based PSA screening algorithm that adjusts PSA levels to multiples of the median for the same age and incorporates age-specific risk demonstrated good screening performance (detection rate of 90% for a false-positive rate of 2%). The European Randomized Study of Screening for Prostate Cancer shows a 16% reduction in prostate cancer mortality with PSA screening, comparable to reductions achieved in bowel cancer screening. The addition of pre-biopsy multi-parametric magnetic resonance imaging (MRI) screening reduces unnecessary biopsies and over-diagnosis while maintaining detection of clinically significant disease. Together, risk-based PSA testing combined with multi-parametric MRI would prevent an estimated 13 prostate cancer deaths per 1000 men screened every 5 years from age 55, with 9 deaths prevented for every man treated unnecessarily.
Background Vulnerable women face a higher risk of cervical cancer and reduced access to screening. Self-sampling may increase access to human papillomavirus screening. In this article, we report the co-creation of a document to guide the implementation of human papillomavirus self-sampling in Italy.Methods Working CollaBoratively with vulnerable women to Identify the best implementation Gains by SCREEning cervical cancer more effectively in European countries (CBIG-SCREEN) project, a Collaborative User Board has been set up in Italy, including national decision-makers, healthcare providers, and vulnerable women. To ensure that women's direct perspectives were incorporated into the process, informal individual interviews were carried out and brought to the Collaborative User Board meetings. The Collaborative User Board discussion was based on systematic reviews, screening program reports, and Italy's self-sampling pilots. Results were summarized with a matrix of vulnerable groups and barriers to evaluate interventions' potential ability to remove barriers. Considerations were collected in a document for screening program coordinators and decision-makers.Results The Collaborative User Board identified major barriers to cervical cancer screening among different vulnerable groups and assessed five evidence-based strategies to address them: multilingual structured invitation letters, group training led by cultural mediators, training for healthcare professionals, training for third-sector operators, and self-sampling. Evaluating the potential of these strategies to remove barriers led to a focus on self-sampling. Mailing the device to all non-responders was the only strategy with sufficient evidence to increase participation in Italy. An opportunistic offer in a setting attended by vulnerable women is promising. The Collaborative User Board underscored the importance of improving healthcare providers' communication.Conclusions The final document, created through a transparent and collaborative bottom-up process, collects considerations for implementing self-sampling for human papillomavirus testing.
ObjectiveTo examine spoilt faecal immunochemical test kit data for associations with ethnicity, gender, socioeconomic deprivation and age. Colorectal cancer outcomes in New Zealand remain poor compared with other countries, with diagnostic delays contributing to inequities. A proportion of faecal immunochemical test kits returned to the National Bowel Screening Programme are spoilt due to participant errors, causing further delays.MethodsA cross-sectional analysis was conducted on National Bowel Screening Programme data from 2012 to 2022, which includes all participants aged 60-74 years who returned a spoilt faecal immunochemical test kit. Spoilt kit reasons were compared by ethnicity using chi-square tests, and logistic regression assessed associations with demographic factors.ResultsOf 432,885 returned kits, 32,754 (8.2%) were spoilt. Asians had the highest proportion spoilt (10.7%), followed by Pacific Peoples (9.2%), Europeans (7.2%) and Māori (6.8%). Compared with Europeans, Asians had 53% higher odds and Pacific Peoples 19% higher odds of returning a spoilt kit, while Māori had slightly reduced odds. Men and participants living in higher deprived quintiles also had increased odds of spoiling a kit. While missing collection dates were the primary reason for spoilt kits (53.2%), transit delays emerged as a disproportionate barrier for Māori (25.6%), while Pacific Peoples (17.5%) experienced rates similar to Europeans (18.2%).ConclusionsExisting interventions appear to benefit Māori in reducing errors, yet they remain vulnerable to systemic issues like transit delays. The program faces a challenge: addressing the higher rates of participant errors among the Asian and Pacific populations, while simultaneously mitigating the impact of postal infrastructure on Māori.
