Bowel cancer screening campaign

Be clear on cancer banner

Essential info

Want and overview of the campaign and help to prepare for the campaign?

Cancer Research UK (CRUK) and Public Health England (PHE) will carry out a regional Be Clear on Cancer campaign across the North West of England to increase participation of 60-74 year olds in the NHS Bowel Cancer Screening Programme. The pilot campaign will run from 9 January to 2 April 2017, with the aim of raising awareness and uptake of bowel cancer screening amongst the eligible population.

On this page you will find essential information about the campaign, including a briefing sheet designed to provide an overview of the activity and support key groups during the campaign. This content is intended for health care professionals and those who work in the community promoting cancer information. A separate webpage has been set up for the public to provide them with information on the campaign.

View the campaign announcement

View the campaign overview briefing sheet

Download the communications toolkit

Essential information about this campaign

A briefing sheet has been produced by CRUK. It is designed to provide local teams with an overview of the forthcoming bowel cancer screening campaign and to help them prepare for the campaign. The briefing is electronic with links to further information and are print friendly. Please share this briefing with NHS, PHE and Local Authority (Public Health) colleagues who will find it useful to hear about the campaign.

Briefing Sheet

Overview briefing sheet

Bolton Bowel Cancer Screening Centre briefing sheet

Cheshire Bowel Cancer Screening Centre briefing sheet

Cumbria and Morecambe Bay Bowel Cancer Screening Centre briefing sheet

Lancashire Bowel Cancer Screening Centre briefing sheet

Liverpool & Wirral Bowel Cancer Screening Centre briefing sheet

Manchester Bowel Cancer Screening Centre briefing sheet

Merseyside & North Cheshire Bowel Cancer Screening Centre briefing sheet

Pennine Bowel Cancer Screening Centre briefing sheet

Leaflets

A range of additional Be Clear on Cancer materials have been developed to support the bowel cancer screening campaign. These include leaflets and posters that are available to download and print locally as required. The leaflet has been designed to give information to the public about the campaign and bowel cancer screening, and is available in a number of accessible formats below.

Leaflet (A4 for office printing)

Leaflet (tri-fold for professional printing)

Easy read leaflet

Large print leaflet

Audio 'leaflet'

British Sign Language (BSL) 'leaflet'

Posters

The poster artwork is available in two sizes. Each version features different members of the target audience. Download versions appropriate for your local area:

White British male poster (A4)

White British male poster (A3)

White British female poster (A4)

White British female poster (A3)

South Asian couple (A4)

South Asian couple (A3)

South Asian female (A4)

South Asian female (A3)

South Asian male (A4)

South Asian male (A3)

Black male poster (A4)

Black male poster (A3)

These resources can also be found within the Public Health England Campaign Resource Centre.

Video

A short animated film, explaining how to complete the bowel cancer screening test for use on GP Practice TV screens, within community outreach work etc

Download this animation

Download a version of this animation with subtitles

Information card

Cancer Research UK Bowel Screening Information card - Intended for use by Health Professionals following a brief intervention regarding bowel cancer screening

Order printed copies of the information card

Infographics for community outreach work

A4 infographic card ‘How to complete your bowel cancer screening test’ – intended for use by community outreach workers

Download infographic

Order printed copies

If you have any questions or queries regarding available materials, please contact helen.oconnor@cancer.org.uk

Be Clear on Cancer aims to achieve earlier diagnosis of cancer by raising awareness of the signs and symptoms. The campaigns encourage people with relevant symptoms to see their GP without delay.

A previous national Be Clear on Cancer campaign in 2012 aimed to raise awareness of the symptoms of bowel cancer, however a bowel cancer screening awareness campaign has never run before. The activity for the forthcoming campaign is based on CRUK’s three pilot campaigns, in London (2014), Wales (2015) and England (2015-16). The Department of Health (DH) helped to fund CRUK’s first pilot and has supported the Wales and England projects.

PHE is working in partnership with CRUK on this campaign in support of the specific recommendation from the Independent Cancer Taskforce strategy “Achieving World Class Outcomes: A Strategy for England 2015 to 2020” for PHE to “explore the use of the Be Clear on Cancer brand to improve uptake of screening programmes, particularly among disadvantaged groups”. If the pilot shows promising results, the long-term ambition of this partnership is for PHE to roll the campaign into their regular programme of Be Clear on Cancer work.

CRUK will lead, fund and evaluate this regional pilot however PHE, DH and NHS England colleagues will provide consultancy, support with the engagement of stakeholders, and produce some campaign materials.

Bowel cancer is the fourth most common cancer and the second most common cause of cancer death in the UK[1], and trials show that bowel cancer screening can reduce deaths from the disease by 15% in the target population (60-74 year olds).[2]

However, there is low uptake of bowel cancer screening across England (58% in 2014). In some areas, particularly the North West, uptake is as low as 40%.[3]

These are some of the reasons why the North West was chosen as the pilot site for this campaign:

  • The North West was carefully selected based on a number of criteria including current uptake, incidence and mortality of bowel cancer, deprivation, population size of 60 – 74 year olds and local support for the campaign aims
  • The North West holds a high density of 60-74 year olds and uptake is among the poorest in England in some parts of the region. By focussing marketing activity in this area, it is targeted to those in greatest need.

Evidence indicates that 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.[4]

Therefore, this Be Clear on Cancer campaign aims to improve outcomes for people in the North West by increasing awareness of the Bowel Screening Programme and encouraging greater uptake of the screening test (specifically, gFOBT).

  1. Cancer Research UK, UK, http://www.cancerresearchuk.org/healthprofessional/cancer-statistics/statistics-by-cancer-type/bowelcancer, Accessed August 2016.
  2. Hewitson P et al. (2007). Screening for colorectal cancer using the faecal occult blood test Hemmoccult. Cochrane Database System Review. Accessed August 2016.
  3. Cancer Research UK, http://www.cancerresearchuk.org/cancer-info/cancerstats/local-cancer-statistics/. Accessed August 2016.
  4. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/bowel-screening-projects-and-resources/evidence-on-increasing-bowel-screening-uptake. Accessed August 2016.

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 NHS bowel screening kit in the post every two years.
  • It’s meant for people with no symptoms.
  • It can detect bowel cancer early, when it is easier to treat successfully
  • So don’t ignore it, take the test.
  • Be Clear on Cancer’

The campaign will run from 9th January to 2nd April 2017. An advertising campaign including TV, posters at bus stops, adverts in newspapers and on Facebook will run for 12 weeks from 9 January to 2 April 2017.

Advertising will run for the full campaign period, whilst direct mail will run alongside advertising from 20 February to 2 April only. Direct mail will consist of two versions:

  • Version one: A personalised CRUK endorsement letter, sent to First Timers only (i.e. those being invited to bowel screening for the first time).
  • Version two: A personalised CRUK endorsement letter and a pack containing 3 pairs of latex-free gloves, sent to Non-Responders only (i.e. those who have been invited previously but have never responded).

The mailings will arrive two-three days following an NHS bowel screening test kit. Previously screened invitees will not be targeted with the CRUK direct mailing.

Advertising and direct mail will run across the North West of England (Granada TV region). This will include, Lancashire, South Cumbria, Greater Manchester, Merseyside and Cheshire, however some CCG areas will act as control areas for direct mail, and therefore won’t receive the activity (control areas TBC). This will enable us to compare the impact of advertising on its own and advertising plus direct mail. Previously screened invitees will not be targeted with the CRUK direct mailing. 

The campaign is aimed at 55-74 year olds from lower socioeconomic groups, with a skew towards men. This targeting will allow the campaign to reach both those currently eligible and soon to be eligible for screening, and to focus advertising on those least likely to participate.[1]

The advertising will be focussed on targeting lower socioeconomic groups, particularly men, since we know that deprived men are least likely to participate in bowel cancer screening.

  1. England bowel screening data for FY 2014/15, persons aged 60-74, “Percentage of people adequately screened out of those invited for FOBt screening” were provided by PHE Screening on request April 2016.

Potential impact of the campaign

Based on modelling data prepared by CRUK1, should the campaign achieve its target of a 10% increase in bowel screening programme participation amongst First Timers and 3% increase in uptake in Non-Responders, across all 32 Clinical Care Groups (CCGs) where the campaign is running, there would be an estimated:

  • Additional 520 people adequately screened[1] per week
  • Additional 15 colonoscopies per week

Following one month of advertising and direct mail activity[2]

Note: Advertising and direct mail activity will run for final 6 weeks of the 12 week campaign only, first 6 weeks will consist of advertising only. Direct mail will not run in every CCG, some will act as control areas.

  1. Reached a definitive result (‘Normal’ or ‘Abnormal’)
  2. Estimates calculated by CRUK Analysis and Evaluation team using the average number of invitations sent per day during 2014 and 2015 and percentage uptake data (2015/16) for first-timers and non-responders. First-timers were estimated to make up 19% of all invitations and non-responders 36%, based on results from previous CRUK bowel screening pilots. Data were supplied by the Bowel Cancer Screening Programme for each campaign CCG. Using these data, the estimated potential increases in the number of people adequately screened and number of colonoscopies, should the campaign achieve a 10% increase in uptake amongst first-timers and a 3% increase in uptake amongst non-responders were calculated. Number of colonoscopies was estimated as 2.82% of those adequately screened (calculated by Cancer Research UK from Annual Report Bowel Cancer Screening Programme, London Programme Hub, April 2011 – March 2012).

Regional NHS Screening and Immunisation teams and their providers are being consulted regularly throughout the development phase of the campaign, with the aim of understanding pressures on capacity. Regional modelling data has also been developed and shared with Screening Centres, to help them prepare for the anticipated increase in demand for diagnostic services.

View the estimated impact on screening centres report

This is a pilot campaign and the first time that TV advertising and the Be Clear on Cancer brand will be included in a bowel cancer screening awareness campaign. Therefore, it is hard to say exactly what impact the campaign will have. Although we do not expect there to be a significant increase in people visiting their GP practice as a result of this campaign, it may prompt those with symptoms to take action. The advertising is not directing people to their GP and focuses on how people should complete the screening kit in their own homes. A GP features in the advert because qualitative research with the target audience during the development stage of the campaign highlighted that a GP endorsement will reinforce the importance of bowel cancer screening.

Those who work in primary care, in pharmacies, GP practices or providing community health services may get asked questions by their patients and customers during the campaign period. We therefore advise that information about the campaign is shared with primary care teams so they are aware of the activity and prepare to answer queries. 

Evidence

While Be Clear on Cancer campaigns have run in England since 2010, this is the first time activity will be used to support one of the national cancer screening programmes. Previous Be Clear on Cancer symptom-focused campaigns have shown positive changes in attitudes and behaviours related to recognising and acting on the signs of cancer, including increasing awareness of bowel cancer symptoms.

The activities for this campaign are based on the results from pilot campaigns on bowel cancer screening which were carried out by CRUK:

London pilot (Feb – Mar 2014)

A pack (containing gloves and poo catchers) and endorsement flyer achieved a greater impact when supported with advertising:

  • increased uptake by 6.1 percentage points among 60-69 year olds
  • increased uptake by 7.3 percentage points among 70-74 year olds

Wales pilot (Feb – Mar 2015)

A personalised CRUK endorsement letter was found to:

  • increase uptake by 9.1 percentage points among ‘First Timers’

A letter including a pack (containing latex-free gloves) was found to:

  • increase uptake by 3.2 percentage points among more deprived ‘Non-Responders’

As with all Be Clear on Cancer campaigns, evaluation metrics for the campaign have been developed in consultation with a range of experts. These include:

  • impact of advertising on awareness, knowledge and attitudes via a pre and post survey

Monitoring calls to the Bowel Cancer Screening Helpline, tracking what prompted calls The impact of the campaign on bowel cancer screening uptake will be analysed across a range of metrics, including:

  • by screening history, age, gender and deprivation in target areas
  • comparison of those invited pre-campaign vs comparison areas not exposed to advertising

The campaign’s impact on services will also be analysed:

  • by number and waiting times for Specialist Screening Practitioner (SPP) appointments and colonoscopies
  • by 62 day wait from NHS screening programme urgent referrals, and all suspected bowel cancer urgent referrals, to first treatment
  • by collecting data and reporting from Screening Centres on increases in demand pre/during/post campaign
  • via questionnaire for patients attending SSP appointment and/or colonoscopy
  • via GP attendance data

Some cancer outcomes data will also be analysed:

  • Number of pre-cancerous adenomas/polyps and cancer detected through screening
  • Overall number of bowel cancers diagnosed

Be Clear on Cancer statement

Be Clear on Cancer  is 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.

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