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  • Health & Medicine

Early diagnosis saves lives – and here’s the evidence

by Henry Scowcroft | Analysis

3 December 2009

1 comment 1 comment

Professor Jane Wardle and her team

It’s been a big week for cancer news, as we blogged about yesterday.

The Government’s report on progress against the Cancer Reform Strategy showed how much cancer survival varies across the country, and another story presented figures from Professor Mike Richards, National Cancer Director, estimating that earlier diagnosis could save between 5,000 and 10,000 lives a year.

The National Awareness and Early Diagnosis Initiative (NAEDI) was set up to tackle these problems. The initiative supports local projects and new research, together with lots of other activities that aim to promote early cancer diagnosis. But until now, the evidence that backs up the initiative was scattered around.

So that’s why the latest supplement of the British Journal of Cancer – published this week – is really important. It sets out, in one place, key evidence and new research that underpins the initiative.

We’ve already heard about Professor Richards’ paper and his estimate of the ‘size of the prize’ for early diagnosis. Here we take a look at two other papers from the supplement – one looking at bowel screening, and another looking at awareness of cancer symptoms.

Bowel cancer screening – who’s taking up the invitation?

The bowel screening programme is the latest to be introduced in the UK. Now that its roll-out is almost complete, a team of researchers at University College London looked at how many people in London returned their bowel screening kits, and more importantly, what made people more or less likely to return them.

They found that the most affluent people were 50 per cent more likely to take part in the bowel screening programme – only 1 in 3 people in the most deprived areas returned their kits, but 1 in 2 people in the most affluent areas did.

Information from the pilot areas (where bowel screening was first introduced) gave an early warning of differences in uptake by socio-economic status. But we still don’t know why people living in more deprived areas are less likely to participate. Professor Jane Wardle, whose team was behind the latest study, called for more research to understand the barriers to participating across all social groups, pointing out:

There’s a real danger that bowel cancer could increasingly become a disease of lower social class if these figures hold true across the UK.

We know that more than 90 per cent of bowel cancer patients survive if the disease is caught at the earliest stage, compared with around six per cent for cases detected at the latest stage.

Screening helps to spot early signs of bowel cancer, as well as pre-cancerous growths that don’t cause any symptoms, so it’s important that everyone who receives a testing kit takes part.

You can find out more about bowel screening on our Spot Cancer Early pages.

How much do we know about cancer?

Diagnosing cancer early becomes much more likely if people with early symptoms of cancer visit their doctor – and for that to happen, they need to be aware that the symptoms they are experiencing could be linked to the disease. So how ‘aware’ is the British public? What can affect ‘awareness’? And how do you measure and evaluate it?

To try to find out more about cancer awareness, Professor Jane Wardle’s group have developed a face-to-face questionnaire – the Cancer Awareness Measure, or CAM – to assess people’s awareness of cancer causes and symptoms, and to unpick their attitudes and barriers to seeing a doctor.

The CAM was put to test in September and October 2008, as part of the Office of National Statistics Opinions Survey. Researchers carried out face-to-face interviews with 2216 people in their homes around the UK, and the results of these surveys are also published in today’s supplement.

The findings are stark. Aside from ‘lump’, which nearly 70 per cent of people identified as a ‘warning sign’ for cancer, awareness of other symptoms –  such as bleeding, weight loss, pain, coughing  or difficulty swallowing – was remarkably low. Generally only about 20 to 30 per cent of people identified these without any prompting.

Women were a bit more aware than men, suggesting that the commonly held conception of men as less concerned about their health – or perhaps in denial – still holds true.

Older people seemed much more aware of cancer symptoms, and socioeconomic status seemed to matter too.  People from poorer backgrounds were able to recall fewer signs of cancer than the well-off.

Respondents were also asked about what might deter them from seeing a GP, and their replies were divided up into ’emotional’ barriers (scared of what the doctor might find, embarrassed, unconfident and so on), ‘practical’ barriers (such as being too busy or having  other things to worry about), and ‘service’ barriers (such as difficulty getting an appointment).

And here, too, there were clear differences between people of different socioeconomic status – people of lower income were far more concerned about emotional barriers, whereas the better-off were more concerned about practical barriers.

Where next?

Understanding where inequalities exist, as well as what might be driving them, is the first step in starting to reduce them.

With the publication of all this evidence, the work done through NAEDI can go from strength to strength. The more we build the evidence base, the better we’ll know what works and what doesn’t. This means we’ll be more effective, and can do more to reduce inequalities.

And if we can go on like this, we’ll be going even further towards meeting Professor Mike Richards’ challenge to save many more lives through earlier diagnosis.

Jess and Henry


von Wagner, C., Good, A., Wright, D., Rachet, B., Obichere, A., Bloom, S., & Wardle, J. (2009). Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England British Journal of Cancer, 101 DOI: 10.1038/sj.bjc.6605392

Stubbings, S., Robb, K., Waller, J., Ramirez, A., Austoker, J., Macleod, U., Hiom, S., & Wardle, J. (2009). Development of a measurement tool to assess public awareness of cancer British Journal of Cancer, 101 DOI: 10.1038/sj.bjc.6605385


  • Devra Davis
    4 December 2009

    We are unable to determine whether early diagnosis alone accounts for these findings or whether this is a result of lead-time bias


  • Devra Davis
    4 December 2009

    We are unable to determine whether early diagnosis alone accounts for these findings or whether this is a result of lead-time bias