Bowel cancer screening campaign: Wales

Be Clear on Cancer logo for bowel campaign

Support the campaign

Get essential information and find out how you can support bowel screening.

Briefing sheet

GP Good Practice Guide

Cancer Research UK and Public Health Wales will launch a Be Clear on Cancer, Bowel Cancer Screening campaign across Wales from 5 February to 31 March 2018.

The aim of the campaign is to raise awareness of the NHS Wales Bowel Cancer Screening Programme (guaiac Faecal Occult Blood Test/ gFOBT), encourage more people aged 60-74 to participate in bowel cancer screening and, therefore, improve early diagnosis of bowel cancer.

The advertising campaign (including TV) will target those eligible (60-74 year olds) and soon-to-be eligible (55-59 year olds) for bowel screening and focussed on engaging lower socioeconomic groups and men.

Essential information about this campaign

Screening provides one of the best opportunities to diagnose bowel cancers at an earlier stage when treatments are more likely to be successful. When diagnosed at its earliest stage, more than 9 in 10 people in England with bowel cancer will survive their disease for five years or more, compared with less than 1 in 10 people when diagnosed at the latest stage.[1] Trials show that bowel cancer screening can cut deaths from the disease by 25% in by those screened.[2]

However, in Wales, uptake of bowel screening remains below the national target of 60% and much lower than other cancer screening programmes, with national uptake of 54.4% in 2015-16 and very low uptake in more deprived areas of some health boards (37.9%).[3]

As well as low uptake, Wales has been selected for this campaign because it has high bowel cancer incidence and mortality rates compared to the UK average[4,5] (bowel cancer is the fourth most common cancer in Wales[6]) and has a high density of the target audience (60-74 year olds, low socioeconomic group) and strong stakeholder support for the campaign.

 

References

[1] Data provided by The National Cancer Registration Service, Eastern Office on request. Similar data can be found here: http://www.ncras.nhs.uk/ncrs-east/
[2] Hewitson P et al. (2007). Screening for colorectal cancer using the faecal occult blood test Hemmoccult. Cochrane Database System Review.
[3] Bowel Screening Wales. (2017). Annual Statistical Report 2015/16. (37.9% is the uptake of the most deprived areas (q5) of Cardiff and Vale UHB). Available at: http://www.bowelscreening.wales.nhs.uk/opendoc/301909 Accessed December 2017
[4] Cancer Research UK. Bowel cancer incidence statistics for Wales. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence#heading-Zero. Accessed December 2017
[5] Cancer Research UK. Bowel cancer mortality statistics for Wales. Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/mortality#heading-Zero. Accessed December 2017.
[6] Ranking compares number of new cases of bowel cancer (ICD C18-C20) diagnosed 2013-2015 in Wales with all cancers (C00-C97, D32-D33, D35.2-D35.4, D42-D43, and D44.3-D44.5. exc C44).

The key message for the public is ‘This little kit could save your life’.

Other key messages include:

  • If you're aged 60-74 you'll be sent a free bowel cancer screening kit in the post, once every two years
  • It's meant for people with no bowel related symptoms at all
  • It can help detect the disease early, when it's easier to treat
  • So don't ignore it, take the test
  • Be Clear on Cancer

The campaign includes adverts on TV, Video-on-Demand, in newspapers and on Facebook. Advertising will run on these channels across Wales for 8 weeks from 5 February to 31 March 2018.

The campaign is aimed at people eligible for gFOBT bowel cancer screening (60- 74 year olds) and soon-to-be eligible (55-59 year olds). The advertising will be targeted to lower socioeconomic groups, and skewed towards reaching men as:

  • Bowel cancer is more common among most deprived men
  • Males are more likely than females to die from the disease
  • Men aged 60-69 are less likely to participate in the NHS Wales Bowel Cancer Screening Programme (gFOBT specifically) than females of the same age.

We appreciate the pressures that GP Practices are under, but research shows that endorsement by GPs can significantly increase uptake, so your support for this campaign is vital.[1] You can:

Display the ‘Be Clear on Cancer’ bowel cancer screening posters and leaflets in your practice to alert eligible participants about the NHS Wales Bowel Screening Programme.

Be Clear on Cancer bowel cancer screening poster (White Female)

Be Clear on Cancer bowel cancer screening poster (Black Male)

Be Clear on Cancer bowel cancer screening poster (White Male)

Be Clear on Cancer bowel cancer screening poster (Asian couple)

Be Clear on Cancer bowel cancer screening leaflet (English)

Be Clear on Cancer bowel cancer screening leaflet (Welsh)

 

Support your patients so that they can make an informed decision about whether they wish to take part in screening or not.

  • Identify and follow up with non-responders or first-timer patients who may not have accessed bowel screening to date. An automatic pop-up alert for non-responders can be activated so you can discuss with your patients during their next visit to your surgery.
  • Talk to patients opportunistically about the bowel cancer screening test during consultations, answer their questions and concerns and encourage them to read the information that comes with their kit so that they can understand more about the role of screening in detecting bowel cancer early and decide about whether to take part.
  • Break down barriers to participation including concerns around hygiene by explaining how to do the test. Reassure patients that the test is free and they can do it in their own home. Use the infographic to aid your conversation: English language version or Welsh language version or direct them to a short animation that they can watch at home. Accessible films are also available.
  • Signpost to good quality information such as the confidential Bowel Screening Wales freephone helpline on 0800 294 3370, further patient information and Bowel Screening Wales’ patient resources
  • Remind patients that bowel screening works better if people take part each time they’re invited, even if previous results have been normal

 

Endorse bowel cancer screening.

Evidence based interventions such as a personalised letter sent from an individual’s GP endorsing the screening programme alongside the screening kit, have been found to increase gFOBT by 5.8% and by 11.8% (when sent in combination with enhanced patient information.[1]  Telephone advice and face-to-face health promotion have been shown to increase gFOBT uptake by around 8 percentage points and 5 percentage points, respectively, when used in combination with a GP endorsement letter sent two weeks following the person’s screening due date.[2]

Your GP Good Practice Guide also offers practical advice to support practices to act if they would like to.

Explore the evidence for why primary care endorsement can increase uptake and example case studies

 

Contact CRUK Health Professional facilitators who are also able to offer advice and local statistics for your area (Abertawe Bro Morgannwg, Aneurin Bevan and Cardiff & Vale University). Email facilitators@cancer.org.uk for more information.

 

References

[1] 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” Brit J Cancer 2011;9;105(4):475-80. Available at https://www.ncbi.nlm.nih.gov/pubmed/21829202. Accessed December 2017
[2] Shankleman J, Massat N, Khagram L et al. Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas. Brit J Cancer 2014;23;111(7):1440-7

 

Evaluation

Yes, this campaign ran as a pilot in the North West of England in between February and April 2017 and interim results are encouraging:

Advertising increased uptake across all screening history groups by 2 to 4 percentage points, with indications of a larger impact among more deprived ‘first timers’ and ‘previous non-responders’, than among less deprived. This is encouraging since when someone participates once, they are more likely to do so again in future and previous non-responders are hardest to engage.

Find out more about CRUK’s previous pilots

Evidence indicates fear of the test outcome, being asymptomatic, having a low perceived risk of bowel cancer and concerns about the practicalities and cleanliness of the screening test can act as barriers to participation. CRUK’s previous pilots all aimed to explore ways of improving participation of 60-74 year-olds in the Bowel Screening Programme and removing barriers to participation. 

Bowel cancer screening uptake will be analysed by screening history, gender and deprivation and compared to those invited in a pre-campaign control period. The impact of advertising on awareness, knowledge and attitudes will also be measured with pre- and post-campaign surveys, and we hope to model the estimated impact of the campaign on the number of bowel cancers diagnosed.

Impact on services

It is not anticipated that there will be a significant increase in GP practice visits because of this campaign, since the advertising will not be directing people to their GP. However, it is advised that practice teams are aware of the campaign and can answer related patient queries.

If the campaign achieves a 5% increase in uptake amongst all screening groups (first-timers, previous non-responder and previously screening); across Wales there would be an estimated;

  • Additional 1,200 people screened* during each month of activity**
  • Additional 15 colonoscopies during each month of activity***

Modelling data relevant to each Health Board has also been calculated and supplied to the Welsh Bowel Screening Centre to help them to prepare as best they can for the anticipated increase in demand for diagnostic services.

 

*Participants returning a used test kit within six months following their invitation
**Estimates have been calculated using the number of invitations sent to the eligible population in each Health Board 2015/16 and percentage uptake by screening history for Wales. Cancer Research UK calculated the estimated potential increase in the number of people screened and the number of colonoscopies, should the campaign achieve a 5 percentage point increase in uptake amongst first-timers and previous non-responders and a 5 percentage point increase in previously screened.
***Number of colonoscopies was estimated using the positivity rate (1.3%) from all bowel screening kits achieving a definitive result, and the percentage attending colonoscopy in each Health Board.
Photo of Dr Ghanghro

 

Dr Ghanghro, based in Cardiff said “I support bowel screening because it can help in early detection of cancer, which leads to better treatments and better long term survival rates.

I recommend my patients complete their bowel screening test when it arrives through the post and encourage them to read the leaflet sent with their test kit, to help them decide whether to take part, because bowel cancer screening is a personal choice."

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