Bowel cancer campaign: Overview

Following the successful regional Be Clear on Cancer bowel cancer pilot in early 2011, the Department of Health launched the first national Be Clear on Cancer campaign to raise awareness of bowel cancer signs and symptoms in January 2012 (Jan-Mar 2012).

A follow-up national campaign then ran from 28 August until the end of September 2012. The adverts appeared on TV and radio. The advertising was a little less intense than the first national bowel campaign.

Three areas of England also piloted the impact of using different approaches to sustain the national bowel activity beyond the campaign period, until March 2013. These three pilots covered North London and North East London; North West England; and Yorkshire TV region.

The campaign highlights two key symptoms of bowel cancer: See your doctor straight away if, for the last three weeks, you’ve had blood in your poo or looser poo.

The aim of the campaign is to encourage more people with these symptoms to go and see their GP earlier.

The Department of Health reviewed the latest evidence and engaged with clinical experts when deciding which key symptoms to focus on. The campaign focuses on the symptoms ‘blood in poo’ and ‘looser poo’ that have persisted for 3 or more weeks, because these are the most common in those diagnosed with bowel cancer.

Although NICE Guidelines state that patients should have these symptoms for six weeks, the campaign advises people with the key symptoms to see their GP after only three weeks. It is hoped that this shorter timescale will encourage people with potentially serious symptoms to go and see their GP promptly.

There are other symptoms of bowel cancer highlighted in the public-facing materials and on NHS Choices:

• A pain or lump in your tummy
• Feeling more tired than usual for some time
• Losing weight for no obvious reason

Public Health England and the Department of Health aim to use everyday language to help people feel more comfortable when discussing symptoms of bowel cancer with their GP. During development of the creative materials, a number of different terms were tested with the target audience and feedback showed that 'poo' was the most commonly used term.

Men and women from lower socioeconomic groups over the age of 55, and the people who influence them, such as friends and family. 

Bowel cancer affects both men and women but is more common in older age, with 90% of people diagnosed aged over 55. Risk factors include diet (eating too much red or processed meat and too little fruit and vegetables), being overweight or obese, low levels of physical activity, drinking alcohol and smoking.

Those with a family history of bowel cancer are also more at risk, especially people with a first degree relative diagnosed with the disease (for example, a parent or sibling).

Screening is a very important part of diagnosing bowel cancer early and it is referenced in the Be Clear on Cancer leaflet that the Department of Health produced. In England, men and women aged between 60 and 69 years old are sent a stool testing kit (faecal occult blood test) every two years. However, the Be Clear on Cancer campaign aims to target symptomatic patients, therefore screening is not mentioned in the TV advert or posters. The reason for this approach, is to keep the campaign message simple and direct.

However, this campaign is an ideal opportunity for GPs and other healthcare professionals to prompt any patients aged 60+, to return their screening kit. Although GP practices are not directly involved in the delivery of the NHS Bowel Cancer Screening Programme, you will be notified when invitations for bowel cancer screening are being sent out in your area. It’s really important that people do use the screening kit when it arrives in the post. It can help detect bowel cancer early, before any symptoms appear.

If a customer or patient has symptoms of bowel cancer, they should visit their GP without delay. Even if they are waiting for or have just returned their screening kit, or have recently had a negative result.

Bowel cancer is the third most common cancer in the UK. Around 34,000 people are diagnosed with bowel cancer [1] in England every year and around 13,200 people die from the disease [2].

Outcomes in the UK are worse than those in comparable European countries and it is estimated that around 1,700 deaths from bowel cancer could be avoided each year if survival rates were as good as the best in Europe.

Over 93% of bowel cancer patients diagnosed with the earliest stage of the disease survive five years, compared with less than 7% of those diagnosed when the disease is at the most advanced stage . Only 9% of patients in England are currently diagnosed with bowel cancer when it is at the earliest stage.

References:

1. Data were provided by the Office for National Statistics on request, June 2012. Similar data can be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations

2. Office for National Statistics Mortality Statistics: Deaths registered in 2010, England and Wales 2010, National Statistics: London

Early diagnosis of cancer is a very high priority for the Government. That is why the Improving Outcomes: A Strategy for Cancer put an emphasis on improved GP access to key diagnostic tests (MRI brain, non-obstetric ultrasound scan, chest x-ray, colonoscopy and flexible sigmodoiscopy) to support the diagnosis of a number of cancers. The Strategy is backed by over £750 million, including over £450 million to support early diagnosis of cancer.

Patients urgently referred for suspected cancer by their GP still have a right to be seen within two weeks under the NHS Constitution. According to the most recent statistics available 95.4% of patients were seen by a specialist within two weeks.

The Department of Health put additional funding into Primary Care Trust baselines to meet the cost of any additional treatment resulting from work to improve earlier diagnosis, and alongside National Cancer Action Teams and the cancer networks, has been working with local NHS teams to estimate any potential impact.

The Department of Health has recently published 'Direct access to diagnostic tests for cancer; best practice referral pathways for general practitioners'. It provides information on direct referral by GPs to specific diagnostic tests for the assessment of particular symptoms where cancer may be suspected but the urgent GP referral (two week wait) process is not applicable. It aims to help GPs in determining which patients would be suitable for direct referral to local services providing the diagnostic tests.

You may have a few patients coming to you with concerns about a family history of bowel cancer. If you feel their concerns require further investigation, you can direct them to local genetics clinics.

The Be Clear on Cancer materials promote the potential benefits of early presentation and reassure people that the symptom is unlikely to be cancer, but that it’s best to get it checked. Its tone is balanced, practical and reassuring.

There was overwhelming support from the public following the first national bowel cancer campaign, with 92% of the public thinking it is important that adverts like this are shown.

For more information, or if you have any queries, please contact partnerships@phe.gov.uk.