Pen power – fighting cancer with information

A letter from the GP can improve bowel screening uptake

Sometimes, surprisingly simple things can help solve incredibly complex problems.

Fascinating research published today in the British Journal of Cancer, shows the impressive – and potentially life-saving – power of the written word. Researchers have shown that by simply helping people better understand bowel cancer screening and offering them support from their GP, you can increase how many people take part.

Why is this exciting? Because this programme helps to detect bowel cancer at an early stage, when treatment is more likely to be successful – so encouraging more people to take part could lead to fewer people dying from bowel cancer.

Bowel cancer – key stats

Bowel cancer is the second biggest cancer killer in the UK, claiming more than 16,000 lives every year.

And although more than nine out of ten people with bowel cancer survive for at least five years if diagnosed at the earliest stage of the disease, only a small percentage of UK bowel cancers are caught at this stage (13 per cent according to the researchers).

To help address this, the national screening programme was introduced in spring 2006. Our scientists have predicted that this programme could save over 2,000 lives each year by 2025.

What is bowel screening?

At the moment, people receive an invitation letter and information booklet about the programme by post when it’s their turn to be screened. Then, a week later, they receive the test kit, which includes brief instructions on how to use the kit and a freepost envelope to send it back.

The test is based on sampling your faeces so that scientists can perform a test – the faecal occult blood test (FOBT) – which looks for hidden traces of blood in your stools. These traces can be a sign of bowel cancer.

It’s a simple test, with life-saving outcomes for some. But there’s no getting away from the fact that some people find the mechanics of it a little objectionable.

This animation from the NHS explains how the kit is used:

[youtube=http://www.youtube.com/watch?v=DY2VHUiOzws]

Helping people understand screening

None of the UK’s cancer screening programmes‘ uptake is ever 100 per cent. In the case of the bowel screening programme, there could be many reasons for this – from simply forgetting to reply, to being squeamish about doing the test.

In their new paper, the researchers, based at the University of Oxford and funded by the National Institute for Health Research and the NHS Cancer Screening Programmes, wanted to see whether providing additional information about the bowel screening programme, and a personalised letter from people’s GP, impacted on uptake.

To do this, they randomly assigned around 1,200 men and women registered with 20 general practices in England to one of four groups:

• Group 1 was sent a personally addressed letter (pdf) from their GP surgery that recommended they complete the test, offered support if the individual had any questions about screening, and emphasised the importance of being aware of bowel cancer symptoms
• Group 2 was sent a more in-depth ‘how-to-do-it’ leaflet (pdf) about how to collect and store samples
• Group 3 was sent both the GP endorsed letter and the ‘how-to-do-it’ leaflet
• Group 4 weren’t sent any additional information with their test kit.

The results were emphatic.

Including either the GP endorsed letter or ‘how-to-do-it’ leaflet alone increased uptake by 6 per cent each.

By including the letter and the ‘how-to-do-it’ leaflet together, uptake was increased from 49 per cent to 61 per cent, a rise of 12 per cent.

And if the letter was signed by the individual GP, rather than being signed ‘on behalf of the practice’, uptake went up even more, to 65 per cent.

Although the rise in screening uptake doesn’t seem huge, if it was raised by this much across the country it could save further lives from bowel cancer. This is encouraging news.

The future

The underlying message of this work is powerful. It shows that helping people to understand more about bowel screening, how to do the test, and providing support from people’s GPs helps increase uptake and potentially could save lives.

These GP-endorsed letters and additional ‘how-to-do-it’ leaflets are effective – and relatively cheap. And the researchers point out that their findings are consistent with research from other countries.

Finally, it’s also worth adding that further improvements to the bowel screening programme are on their way.  The English government has committed to adding a second bowel screening test to the programme from next year. The new ‘Flexi-Scope’ bowel screening test uses a camera and light at the end of a flexible tube to detect and remove pre-cancerous growths from the lower parts of the bowel.

Cancer Research UK scientists worked on the trial that proved the benefits of this new test. With the continued support of the public, we will continue to research ways to prevent, diagnose and treat bowel and other cancers.

Oliver Childs

Further information

• NHS bowel cancer screening website for England

Reference

• Hewitson, P., Ward, A., Heneghan, C., Halloran, S., & Mant, D. (2011). Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial British Journal of Cancer, 105 (4), 475-480 DOI: 10.1038/bjc.2011.255