92 Chapter 3 When thinking of clinical relevance and usability of the study findings, our main conclusion is that more effort should be made to engage people living in neighbourhoods with a lower SES-score. Current low-attendance in these areas may lead to a further increasing inequality in cancer survival, in a subpopulation already confronted with several other health-risks and problems. Our study underlines a longstanding hypothesis: people who are possibly the most at risk for the development of an advanced form of cancer, are the less likely to be screened.32 Future development therefore should focus on more specific outreach strategies to engage people living in neighbourhoods with a lower SES-score that are at specific risk of non-attendance, as partly earlier was suggest by Woudstra et al.33 We suggest to encourage healthcare professionals, policymakers and politicians to look into such kind of ‘novel solutions’. We also suggest that GPs, or primary health care professionals in general, take on a more prominent role in promoting and educating people on the CSPs. Previous studies showed that GP-involvement has a positive impact on (cervical) screening uptake, in particular for the classic ‘hard to reach’ subgroups.34, 35 Especially in deprived areas, people generally trust and have a good long-term relationship with their GP, and primary healthcare centres in these areas are the only available link to enter healthcare and to gain information on health issues.36 A remaining question would be, how exactly the role of GP practice centres should be improved while avoiding the risk to further increase workload. Perhaps just being enlisted with a primary healthcare centre, and being invited to participate through that centre, could already make a difference. Conclusion Non-attendance at both the BC and CRC-SPs tends to be associated with living in a lower SES-score neighbourhood. In addition, non-attenders living in these lower SESneighbourhoods, were more often diagnosed with the unfavourable forms of cancer, as targeted by the specific CSPs. Since low screening uptake thus contributes to increasing inequalities in cancer survival, future outreach should be focussed on engaging specific groups of people living in lower SES-neighbourhoods carrying the highest risks.
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