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.


Latest News

Some recent results

Cancer awareness: Areas in England with higher levels of cancer awareness have higher cancer survival rates. This suggests that efforts to promote awareness, for example, the Be Clear on Cancer campaigns, are worthwhile. See http://www.nature.com/bjc/journal/v115/n7/full/bjc2016246a.html?foxtrotcallback=true

Cancer awareness: Some non-malignant comorbidities are associated with increased help-seeeking for potential cancer symptoms but some are associated with delayed help-seeking, for example heart disease patients are less likely to seek help for bowel symptoms. See https://academic.oup.com/jpubhealth/article-lookup/doi/10.1093/pubmed/fdx072

Cancer awareness: In terms of ethnicity, symptom awareness (both visible and functional symptoms) is low in black and Asian populations, with particularly low levels in the black population. Barriers to presentation, especially in terms of other life priorities and communicaiton difficulties, are strongest in the Asian population. See https://www.nature.com/bjc/journal/v115/n1/full/bjc2016158a.html

Cancer screening: Postal reminders increase participation rates in breast cancer screening, including in deprived populations. See http://www.nature.com/bjc/journal/v114/n2/full/bjc2015451a.html?foxtrotcallback=true

Cancer screening: Second timed appointments for non-attenders at breast screening increase participation rates, also in deprived populations. See http://www.sciencedirect.com/science/article/pii/S1470204517303406?via%3Dihub

Cancer screening: Higher detection rates of ductal carcinoma in situ at screening are associated with lower subsequent rates of symptomatic invasive cancer. See http://www.sciencedirect.com/science/article/pii/S1470204515004465?via%3Dihub

Early diagnosis: Thrombocytosis is associated with subsequent diagnosis of cancer and may therefore be a useful marker for early cancer. See http://bjgp.org/content/67/659/e405.long

Early diagnosis: Thrombocytosis may be particularly useful in diagnosing colorectal cancer or inflammatory bowel disease in patients younger than 50 years. See http://bjgp.org/content/67/658/e336.long

Early diagnosis: In an online virtual consultation study, black and older patients with relevant symptoms were less likely to be referred for further investigation. See http://qualitysafety.bmj.com/content/26/6/449.long



Selected Recent Publications

  • Bailey S, Ukoumunne O, Shephard E, Hamilton W. Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using UK electronic medical records and cancer registry data. Br J Gen Pract 2017; 67: e40-5-13.

  • Benton SC, Butler P, Allen K, et al. GP participation in increasing uptake in a national bowel cancer screening programme: the PEARL project. Br J Cancer 2017; 116: 1551-1557

  • Duffy SW, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J, Collins B, Robson T, Scorfield S, Green K, Hall C, Liao XH, Ryan M, Johnson F, Stevens G, Kearins O, Sellars S, Patnick J. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 2016;17:109-14.

  • Friedemann Smith C, Whitaker KL, Winstanley K, Wardle J. Smokers are less likely than non-smokers to seek help for a lung cancer 'alarm' symptom. Thorax. 2016 Jul;71(7):659-6

  • Green T, Atkin K, Macleod U.  GPs’ perceptions and experiences of public awareness campaigns for cancer: a qualitative enquiry. Health Expectations 2016; 19: 377-87

  • Martins T, Hamilton WT. The influence of ethnicitiy on diagnosis of cancer. Fam Pract 2016; 33: 325-6

  • Massat NJ, Dibden A, Parmar D, Cuzick J, Sasieni PD, Duffy SW. Impact of Screening on Breast Cancer Mortality: The UK Program 20 Years On. Cancer Epidemiol Biomarkers Prev. 2016 25:455-62

  • Niksic M, Rachet B, Duffy SW, Quaresma M, Møller H, Forbes LJ. Is cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study. Br J Cancer. 2016; 115: 876-86

  • Niksic M, Rachet B, Warburton FG, Forbes LJL. Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England. Br J Cancer 2016; 115: 136-44

  • Sheringham J, Sequeira R, Myles J, Hamilton W, McDonnell J, Offman J, Duffy S, Raine R. Variations in GPs’ Decisions to Investigate Suspected Lung Cancer: A Factorial Experiment Using Multimedia Vignettes. BMJ Qual Saf. 2016; 26: 449-59
  • Walker S. Hamilton W. Risk of cervical cancer in symptomatic women aged ≥40 in primary care: A case-control study using electronic records. European Journal of Cancer Care 2017 May;26(3). doi: 10.1111/ecc.12706