Title: Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis
Funder: Department of Health (England)

Abstract: Background For many cancers, survival in the UK is poorer than in comparable countries in Europe, North America and Australasia. The differences are seen principally in survival in the first year after diagnosis. This suggests that the reason for poorer survival is late presentation rather than deficiencies in treatment. Recent estimates suggest that around 10,000 cancer deaths per year would be saved if the UK had the same survival rates as the best in Europe. This highlights the need to develop policies that promote diagnosis of cancers at an earlier stage than that prevailing at the moment. These might include policies to enhance access to screening and diagnostic facilities, to improve public awareness of cancer and cancer symptoms, and to encourage prompt seeking of medical advice for symptoms This is the target for The Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis. Aims 1. In the area of cancer awareness, we aim to quantify the relationship between awareness and cancer survival/mortality, and to participate in evaluation of policy interventions to improve awareness. Our contribution to the latter will range from methodology (design of studies, measurement of awareness) to interpretation of results and implications for policy. 2. In terms of screening, our main aims are to estimate the benefits and harms of the national screening programmes, to investigate barriers to screening at individual level, and to research policies aimed at removing or mitigating barriers. We shall also participate in evaluation of new screening technologies. 3. In the area of early diagnosis, our research will be focussed on primary care. It will include qualitative work on the perceptions and attitudes of general practitioners as gatekeepers to diagnostic services, studies of referral triggers in general practice, identification of risk factors for late or emergency presentation, and estimation of the predictive value for a number of cancers of symptoms and histories reported at primary care. In all three areas, there is potential for work across several cancer types. There will be a focus on common cancers responsible for large numbers of deaths in the UK, notably breast, colorectal and lung cancers, but our work will not be limited to these. In researching policy interventions, in addition to estimating the clinical effects of these, we shall also estimate financial and human costs. It is anticipated that the majority of the work of the Unit will be that of our planned programme, but we are aware that we will be called upon to carry out research in response to requests from the Department of Health. Plan of Investigation 1. In cancer awareness, our programme of studies will include • Use of already collected survey data to characterise geographic variations in cancer awareness and estimation at area-level of the relationship between awareness and survival. • Participation in evaluation of community-level interventions to improve cancer awareness. For NAEDI projects, this will take the form of broad overview and interpretation rather than detailed analysis of individual project data. • Development and testing of individual-level policy interventions to enhance cancer awareness. 2. In cancer screening, studies will include: • Case-control evaluation of the effect of the breast and bowel screening programmes on Incidence and mortality from breast and colorectal cancer. This will include estimation of the benefits and harms of detection of ductal carcinoma in situ and of premalignancies in the large bowel. • A survey of individually perceived barriers to screening, with a focus on the likely effects of access interventions, ‘nudges’, and changes to the screening regimen to render compliance easier. • Reviews of technical issues in screening, including the operating characteristics of immunochemical testing in comparison with faecal occult blood testing, and the combination of screening modalities, such as endoscopy and faecal testing. 3. In early diagnosis, studies will include: • A web-based study of GP response to symptoms potentially indicative of lung cancer. This will involve GP’s viewing a number of patient consultation vignettes, and reporting their suspicion of cancer and likely action in terms of referral. Vignettes will be designed to represent a range of risk levels of symptoms, age, sex socioeconomic status and ethnicity of patients. • Qualitative study of GP perceptions of and attitudes to awareness, screening and early diagnosis, with reference to the gatekeeper role of primary care, complemented by quantitative study of practice profile factors and referral rates, particularly two-week referrals. • Case-control studies of lymphoma, leukaemia, myeloma, and cancers of the cervix, uterus, breast, and head & neck, to estimate the predictive potential of symptoms and histories reported in primary care consultations.This complements analogous studies carried out under different funding auspices for other common cancers. Potential Impact As noted above, there is the potential to avoid 10,000 premature deaths from cancer per year if the UK survival rates could match the best in Europe. It is reasonable to suppose that around half of this figure is achievable by improvement in the stage at diagnosis of cancer. In terms of awareness, this should be achieved by development of policies which would deliver earlier presentation by the patient at primary care. For screening, the estimation of the benefits currently being achieved and geographic variation in the magnitude of these will aid development of remedial policies. Also, a major limitation of the potential of screening to reduce mortality is the extent of non-participation of the target group. We aim to identify policy innovations which will improve access to screening and reduce physical or psychosocial disincentives, particularly for bowel screening. In terms of early diagnosis, a major aim is to enhance the ability to recognise the higher risk indicators at primary care and refer accordingly.


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;4.4 POPULATION SCREENING
Health categories: CANCER AND NEOPLASMS