Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis

The Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis is funded by the Department of Health Policy Research Programme. The Unit has an eight-year programme to research policy issues in the three broad areas of cancer awareness, cancer screening, and early diagnosis of cancer, to inform policies for improving stage at presentation of cancer and thus reducing mortality from the disease.

The Unit is a collaboration of 13 leading scientists from seven institutions, with Stephen Duffy of Queen Mary, University of London as director, Rosalind Raine of University College, London as deputy director and Peter Sasieni of Queen Mary, University of London as vice director. Until her tragic death in 2015, our dear colleague Jane Wardle was deputy director. The Unit partners are also involved with other national and international initiatives annd bodies focussed on early diagnosis of cancer, including The International Cancer Benchmarking Partnership (http://www.cancerresearchuk.org/health-professional/data-and-statistics/international-cancer-benchmarking-partnership-icbp), the National Screening Committee and the advisory committees for the breast, bowel and cervical screening programmes (http://www.cancerscreening.nhs.uk/).

Major areas of activity of the Unit include:


• Studies of the predictive value of symptoms for cancer, and of response of GP’s to symptoms

• Identification of the risk factors for late stage or emergency presentation of cancer

• Evaluation of interventions to promote awareness and help-seeking for symptoms

• Evaluation of the benefits and harms of the national screening programmes for breast, bowel and cervical cancer

• Identifying barriers to participation in cancer screening and researching policies to improve access

• Investigation of potential early markers of cancer and new screening tests


For many cancers, there is a strong relationship between survival and the extent to which the cancer has been allowed to grow before diagnosis. Our ultimate aim is to shift cancers from late stage, poor survival, to early stage, excellent survival.

 

Cancer Awareness

Cancer Awareness

The UK has lower short term survival than many other developed countries for a number of cancers. This is likely to be due to later stage at diagnosis. One area of investigation is the role of public awareness of cancer risk, symptoms and the necessity for prompt diagnosis and treatment. Research on this topic in the Unit includes:

Estimation of area-based associations of levels of cancer awareness and survival in England.

This study involved linking local cancer survival rates with survey data on awareness from 46,000 people across England. We found that areas with high levels of cancer awareness had correspondingly higher cancer survival rates.

Studies of the nature and duration of symptoms leading to diagnosis of cancer.

This includes data on symptoms associated with 22 cancer types in 3,371 cancer patients from the Cancer Patient Experience Survey. Major findings included the observation that urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay.  

Evaluation of Interventions to improve awareness of cancer symptoms.

We have piloted implementation of an intervention to promote early presentation of breast cancer among women attending for their final invited mammogram in four breast screening services. Building on this, we plan to carry out a larger pilot involving 60,000 women to examine the effect on breast cancer mortality. A trial of a GP-endorsed awareness intervention targetting those who have disengaged from primary care is under way and will report in 2018.

Surveys of symptoms, awareness and attitudes to help-seeking in the general population

A number of results have emerged from these surveys. These include a number of complexities in attitudes to ‘wasting the GP’s time’, notably a finding that the barrier was enhanced in the presence of visible time constraints. Smokers were less likely to seek help for cancer ‘alarm’ symptoms has now been published. Another analysis of the survey, finding that younger people, those in formal employment and unmarried people were less likely to seek help for ‘alarm’ symptoms. In terms of emotional responses to symptoms, we found that worry is associated with help-seeking but fear with avoiding help-seeking. Body-vigilance was associated with help-seeking, suggesting that this might be a target for health education. 

 

Cancer Awareness

 

 

Cancer Screening

Cancer Screening

The UK has national screening programmes for breast, bowel and cervix cancer. There is an ongoing need for evaluation and improvement of these, and for research on new potential cancer screening interventions. The Unit’s research in this area includes:

Case-control evaluation of the national breast screening programme.

This includes estimation of the programme’s effect in terms of breast cancer mortality, stage of disease and overdiagnosis. It also incorporates evaluation of the combined effects of screening, pathological features of the cancer, and treatment. We have already published results from the London pilot of the study (http://cebp.aacrjournals.org/content/25/3/455.long) and are currently processing the nationwide data.  If you have any interest in or concerns about this study, you are welcome to contact the PRU (using the 'contact us' page on this website). A similar evaluation is at the planning stage for the bowel screening programme.

Use of routine screening data to research issues relevant to policy.

This includes analysis of screening and interval cancer data in the national breast screening programme to assess the effects of changes to the programme such as the introduction of two-view mammography, and to investigate the value of detection and treatment of ductal carcinoma in situ.

Major reviews of cancer screening strategies

We are currently working on a systematic review of the use of ultrasound in addition to X-ray mammography in screening women with dense breast tissue.

Studies of interventions to improve access to and participation in screening

We have found that GP endorsement improves participation in bowel cancer screening, that the offer to change to an evening appointment, postal reminders and second timed appointments for non-attenders, all increase participation in breast screening. Further trials of interventions to improve delivery of and participation in screening are under way.

Major collaborations.

The Unit is also involved in a number of major collaborative studies. These include studies of new technology such as breast tomosynthesis and automated ultrasound in breast screening; tactical issues such as faecal immunochemical thresholds for further investigation, and studies of new screening interventions such as CT screening for lung cancer.