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.