OBJECTIVES: To assess whether people with learning disability in the UK have 
poorer access to cancer screening.
DESIGN: Four cohort studies comparing people with and without learning 
disability, within the recommended age ranges for cancer screening in the UK. We 
used Poisson regression to determine relative incidence rates of cancer 
screening.
SETTING: The Health Improvement Network, a UK primary care database with over 
450 General practices.
PARTICIPANTS: Individuals with a recorded diagnosis of learning disability 
including general diagnostic terms, specific syndromes, chromosomal 
abnormalities and autism in their General Practitioner computerised notes. For 
each type of cancer screening, a comparison cohort of up to six people without 
learning disability was selected for each person with a learning disability, 
using stratified sampling on age within GP practice.
MAIN OUTCOME MEASURES: Incidence rate ratios for receiving 1) a cervical smear 
test, 2) a mammogram, 3) a faecal occult blood test and 4) a prostate specific 
antigen test.
RESULTS: Relative rates of screening for all four cancers were significantly 
lower for people with learning disability. The adjusted incidence rate ratios 
(95% confidence intervals) were Cervical smears: Number eligible with learning 
disability = 6,254; IRR = 0.54 (0.52-0.56). Mammograms: Number eligible with 
learning disability = 2,956; IRR = 0.76 (0.72-0.81); Prostate Specific Antigen: 
Number eligible = 3,520; IRR = 0.87 (0.80-0.96) and Faecal Occult Blood Number 
eligible = 6,566; 0.86 (0.78-0.94). Differences in screening rates were less 
pronounced in more socially deprived areas. Disparities in cervical screening 
rates narrowed over time, but were 45% lower in 2008/9, those for breast cancer 
screening appeared to widen and were 35% lower in 2009.
CONCLUSION: Despite recent incentives, people with learning disability in the UK 
are significantly less likely to receive screening tests for cancer that those 
without learning disability. Other methods for reducing inequalities in access 
to cancer screening should be considered.