25 Sep

What are the results of the study and what impact have they had?

Findings from the ASCEND study have been published in several journals including The Lancet. You can also access more information about this study and its findings on the UCL website.

Only one of the strategies tested, the enhanced reminder, increased the likelihood of people in the most deprived areas participating in screening. In addition, although it did not appear to particularly target more deprived areas, the GP practice endorsement modestly increased the likelihood that people in all areas would participate in screening, so this was also a positive finding.

It is hoped that these new invitation strategies will be implemented in the NHS Bowel Cancer Screening Programme as routine, to help reduce the risk of inequalities associated with screening and to improve overall participation.


Raine R, Atkin W, von Wagner C, et al. Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials. Southampton (UK): NIHR Journals Library; 2017 Mar

Raine R, Moss SM, von Wagner C, Atkin W, et al.  A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening. Br J Cancer. 2016 Dec 6;115(12):1479-1486.

McGregor LM, von Wagner C, Atkin W, et al. Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial. Gastroenterol Res Pract. Vol 2016, Article ID 3670150

Raine R, Duffy SW, Wardle J, et al. Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening. Br J Cancer. 2016 Feb 2;114(3):321-6.

Wardle J, von Wagner C, Kralj-Hans I, et al. Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials. Lancet. 2016 Feb 20;387(10020):751-9