Blood in pee campaign
For information about bladder cancer signs and symptoms for the public, check out our webpage.
Public awareness of the signs and symptoms of cancer can support timely presentation in primary care and drive earlier diagnosis. Be Clear on Cancer (BCOC) campaigns were carried out to raise awareness of key symptoms of cancer and encourage people to go to their GP without delay.
Why were the campaigns run?
In 2013, 3,340 bladder and kidney cancers were diagnosed through an emergency presentation [1]. When people are diagnosed through this route, the majority are likely to be diagnosed with late-stage disease, where treatment is less likely to be successful. Visible haematuria is the most common symptom of bladder [2] and kidney [3] cancers. However, when asked to recall signs or symptoms of cancer via a Cancer Awareness Measure survey, only 16% of the public mentioned ‘blood in pee’ [4].
A regional pilot blood in pee campaign was run in early 2013, followed by national campaigns in England in 2013, 2014, 2016 and 2018.
Who did the campaigns target?
Men and women over the age of 50 from lower socio-economic groups, and the key people that influence them, such as their friends and family, were targeted by the campaign. Advertising included TV, radio, social media (Facebook) and advertising in key locations (eg washrooms).
Different adverts were used for men and women because research showed that men and women may respond differently to finding blood in their urine:
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Men might ignore the symptom, especially if it only happens once.
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The campaign needed to encourage women not to pass the symptom off as a urinary tract infection (UTI). It was estimated that half of all women in the UK will have a UTI at least once in their life, but if they had blood in their urine, they should see their GP.
What were the key messages?
The key message was 'If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.' The advertising also highlighted that finding cancer early makes it more treatable. The campaign aimed to use everyday language to help people feel more comfortable when discussing symptoms with their GP. During testing, the word ‘pee’ was universally accepted instead of urine.
What was the impact of the campaigns?
Results from pilot ‘blood in pee’ campaigns showed that the campaign was successfully changing levels of public awareness. There were also early indications that clinical outcomes were improving too.
Key outcomes included:
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A statistically significant 48% increase in bladder cancer diagnoses in pilot areas following an urgent suspected cancer referral, compared to a statistically significant decrease of 12.3% in control areas [5].
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A statistically significant increase of 47% in kidney cancer diagnoses in pilot areas following an urgent referral, compared to an 8.5% increase in control areas [5].
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Cystoscopy activity significantly increased by 3% (after adjusting for working days) in pilot areas during the campaign period compared to the same period the previous year [6].
Access results from the first and second national campaign in 2013
Read about the impact of the Blood in pee campaigns in the NHS evaluation blog or this article:
A prospective evaluation of the fourth national Be Clear on Cancer ‘Blood in Pee’ campaign in England (Merriel et al., 2022)
Resources
References
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Data supplied by Public Health England using Routes to Diagnosis 2006-2013
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Clinical features of bladder cancer in primary care. Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT. Br J Gen Pract. 2012
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Clinical features of kidney cancer in primary care: a case-control study using primary care records. Shephard E, Neal R, Rose P, Walter F, Hamilton WT. Br J Gen Pract. 2013
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Published Cancer Awareness Measure (2014)
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Obtained through Public Health England, from the National Cancer Waiting Times Monitoring Dataset provided by NHS England
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Cystoscopy data sourced from Hospital Episodes Statistics and the Diagnostic Waiting Times and Activity Dataset
Be Clear on Cancer statement
Be Clear on Cancer was a cancer awareness campaign led by Public Health England, working in partnership with the Department of Health and NHS England. This page contains links to documents that we hope you find useful. Please note however that the views or opinions expressed within those links are not necessarily those of Cancer Research UK.