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.

 

Early Diagnosis

Early Diagnosis of Cancer

While it is known that the earlier that cancer is diagnosed, the better the outcome for the patient, the process of symptoms, consultation with GP, referral to hospital and diagnosis is a complex one, and it is not clear how to achieve earlier symptomatic diagnosis of cancer. Research within the Policy Research Unit on this subject includes:

  • Studies of the predictive power of symptoms or patient histories reported at primary care for various cancers.

    These involve retrieving large amounts of data from general practice databases, to find symptoms and histories which arise at GP consultations in the months before a diagnosis of cancer. The results are used to build up a series of warning signals for GP's to refer patients whose symptoms are associated with certain cancers. Results have already strongly influence NICE guidelines for referral for further investigation.

  • Estimation of the effect of factors such as age, ethnic group and socioeconomic status on GP's referral habits.

    This was done via virtual consultations on the internet. GP's viewed actors playing patients with various symptoms and demographic features. We found that older patients and black patients were less likely to be referred for further investigation. An online education tool has been developed as a result, and this is being trialled in three medical schools.

  • Identification of factors associated with late or emergency presentation with cancer.

    This involves a major data linkage exercise between general practice, cancer registries and other sources. Finding those factors which are strongly associated with late or emergency presentation, will inform policies to avoid these in the future by promoting earlier diagnosis.

  • Possible new markers of cancer in primary care 

    We found that thrombocytosis was associated with subsequent diagnosis of several types of cancer. Work is ongoing to ascertain how the use of platelet counts could promote diagnosis of cancer at an earlier stage.

  • Abdominal pain presenting in primary care

    We plan a large study based on primary care records of abdominal pain in association with other features, and likelihood of cancer.

  • Clinical decision support tools

    We are working on a qualitative study of use and acceptance of a clinical decision support computer aid for upper GI cancer including action taken as a result of the aid, and follow-up interviews 6 months after use of the tool.



Diagram: Quantification of the risk of uterine cancer in symptomatic primary care

People

All participating staff from all sites to be added here....