'Know 4 sure' campaign: Information for pharmacy teams

Campaign materials

'Know 4 sure' briefing sheets and marketing materials (e.g. leaflets and posters) are available on the resources and tools page.

Download campaign materials

We know that pharmacists and pharmacy staff were vital in helping to make the ‘Know 4 sure’ cancer symptoms campaign pilots a success.

We have provided some questions and answers specifically for you to complement other information  on this site, to help you continue to support the national campaign.

This section includes general information for pharmacy-based teams, so please encourage your colleagues to take a look too.

On this page

What is different about this campaign?

Following several tumour-specific cancer awareness campaigns, Be Clear on Cancer has become a well-recognised brand. Therefore, it was timely to pilot a more  general cancer symptoms approach that would work alongside them. ‘Know 4 sure’ was the headline for the new Be Clear on Cancer campaign – it was used in all the adverts and materials.

Why run a more general cancer symptoms campaign?

Around 268,000 people are diagnosed with cancer in England each year - more than 236,000 are aged 50 and over [1]. Outcomes in the Britain are worse  than those in some European countries and it is estimated that 10,000 deaths could be avoided each year if cancer survival matched the best in  Europe [2].

But awareness of signs and symptoms of cancer is low and we know  that people can delay going to see their GP for a number of  reasons.

With more than 200 types of cancer, the Department of Health can’t continue to produce individual campaigns. So, for the first time, this campaign focused on four key symptoms that are indicators for a number of cancers, including less common ones.


1. Source: All cancers excluding non-melanoma skin  cancer (C00-C97 excl. C44). 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. Note: Estimates based on figures provided in  Abdel-Rahman et al (2009)

Why now?

Approximately 10,000 deaths from cancer in England could be  avoided every year if our cancer survival rates matched the European best. The Department of Health’s Improving Outcomes – A Strategy for Cancer set out how it will seek to achieve the ambition to prevent 5,000 deaths from cancer per year by  2014/2015, bringing survival rates in England up to the average for Europe. The  Government’s strategy for cancer includes a range of actions to improve cancer  outcomes, including:

  • reducing the incidence of cancers which are preventable, by lifestyle  changes;
  • improving access to screening for all groups and introduce new screening  programmes where there is evidence they will save lives and are recommended by  the UK National Screening Committee;
  • achieving earlier diagnosis of cancer, to increase the scope for successful  treatment – diagnosis of cancer at a later stage is generally agreed to be the  single most important reason for the lower survival rates in England;
  • achieving earlier diagnosis of cancer, to increase the scope for successful  treatment and making sure that all patients have access to the best possible care and support.

The Be Clear on Cancer campaign is one of a number of actions to achieve earlier diagnosis by specifically seeking to improve public awareness of cancer  symptoms and encouraging earlier presentation.

Find out more about the background to the campaign.

What is the campaign’s key message?

The message for the public is:

'Know 4 sure'

When it comes to cancer, there are 4 key signs to look out for:
1.  Unexplained blood that doesn’t come from an obvious injury.
2. An unexplained lump.
3. Unexplained weight loss, which feels significant to you.
4. Any type of unexplained pain that doesn’t go away.

Chances are it’s nothing serious, but finding it early makes it more  treatable. So if you notice any of these signs, tell your doctor.

Why focus on these four symptoms of cancer?

The agency M&C Saatchi presented a range of possible campaign approaches to an expert panel, which included GPs and secondary care clinicians, who  were asked by the Department of Health to assist in advising on the basic design of the campaign and the key public messages to be used.

A campaign that highlighted a limited number of possible cancer symptoms was agreed to be the optimal approach for non-tumour specific campaign. Four main  symptoms of cancer were identified based on clinical predictors of cancer and  research into the most commonly reported symptoms by cancer  patients. [1]

This approach was tested alongside other potential alternatives with a sample  of GPs and the target audience in two phases of qualitative research. The  outcome of this qualitative research confirmed that the cancer symptoms approach  would be the most effective choice to take to pilot.


1. Hippisley-Cox J, Coupland C.  Symptoms and risk factors to identify women with suspected cancer in primay  care: derivation and validation of an algorithm. British Journal of General  Practice 2013;(in press)

Where will local activities to support the ‘Know 4 sure’ cancer symptoms campaign take place?

Local Cancer Networks worked with the Department of Health to develop activities aimed at reaching people in your community. Activities varied  across the pilots - all included media, such as local press, and some  included community-based work. These ran from 14 January to mid-March 2013.

The pilot campaigns ran in the following Cancer Network areas: North East London and North Central London; Lancashire and South Cumbria, and Greater  Manchester and Cheshire; and Central South Coast.

Activities and adverts highlighted the main message for the public, featuring  the four key symptoms of cancer. The campaign leaflet includes other possible  symptoms of cancer too. The aim is to encourage more people with these symptoms to go and see their GP earlier.

Who is most at risk of cancer?

Cancer affects both men and women, and is more common in older age – almost 9 in 10 cancers in England are diagnosed in people aged 50 and over. There are other risk factors, but they vary across different cancers.

What should I do if I have a concern about a customer?

If you’re a pharmacist and your customer or patient  complains about any of the four key symptoms, or is using an over the counter (OTC) medicine to treat them, urge them to visit their doctor. GPs will be  following the NICE referral guidelines for suspected cancer, which recommend  carrying out diagnostic tests and making an urgent two-week referral as appropriate.

Be confident and, where relevant, give customers  permission to visit their GP. We know that people delay going to see their GP for a variety of reasons. They might be embarrassed,  not realise their symptoms are serious or worry about wasting their GP’s  time.

If you feel comfortable, tell the customer to mention that their  pharmacist sent them. It may be the push they need to get themselves checked  out.

If you are a member of the pharmacy team, be confident and  follow your normal protocol. If you are concerned about a customer and feel  uncomfortable talking about cancer, ask your pharmacist to speak to them or, if  that isn’t possible, urge the customer to go to see their GP and get their  symptoms checked out. It may be nothing serious, but may still need treating. If  it is cancer, it’s better for it to be detected early.

What extra information and support is available for our pharmacy team?

There are resources available to pharmacy staff. One source of support for  frontline staff is a free-to-access toolkit developed by Lancashire & South  Cumbria Cancer Network.

Do activities like this cause unnecessary anxiety?

The Be Clear on Cancer materials highlight the importance of early diagnosis  of cancer and reassure people that their symptoms are unlikely to be cancer, but  that it’s best to get it checked.

There has been overwhelming support from the public following the first  national bowel cancer campaign that ran from January to March 2012. The huge  majority of the public, 92%, said they think it is important for the Government  to be communicating these kinds of messages.

What do I need to do to support the campaign?

Make it part of your day. During your regular consultations,  such as medicine-use reviews, OTC sales or in conversations with customers, be  aware that people might want to talk about the campaign. It may prompt those who  have previously ignored symptoms to mention them to you – they may come to your pharmacy looking for OTC medicines or advice. Or you could mention the campaign when you advise about management of relevant symptoms.

Give permission. We know from  research with the target audience that they delay going to see their GP and often seek permission to make  an appointment. People try to gauge if their symptoms are severe enough. Others  think the GP will not want to see them or it will be a waste of their doctor’s  time. Be confident and urge any customers that mention any of the four key  symptoms to visit their GP. If you feel comfortable, tell the customer to  mention that their pharmacist or a member of the pharmacy team has sent them. It  may be the push they need to get themselves checked out.

Promote the campaign. Put up posters in your pharmacy and ensure you have some campaign leaflets readily  available for customers. You can order hard copies of the ‘Know 4 sure’ cancer  symptoms campaign leaflets and posters free of charge from the Department of Health’s orderline or by calling 0300 123 1002.

Talk about it. Tell your friends, family, customers and  colleagues about the Be Clear on Cancer ‘Know 4 sure’ cancer symptoms campaign.  We need to encourage people to talk openly about cancer. This campaign gives us all the chance to do that.

What other resources are available for the campaign?

A range of additional Be Clear on Cancer materials  have been developed centrally by the Department of Health for the ‘Know 4 sure’  cancer symptoms campaign.

Download an example leaflet

PDFs for these materials are available to download from  this website and can be used alongside posters and leaflets to promote and  support the campaign locally.

From January, the public-facing website for the Be Clear on Campaign is NHS Choices at www.nhs.uk/know4sure.

Is there a briefing sheet for this campaign?

Yes. We know that there isn’t always much time in a busy day to absorb lots of  information, so we have developed a briefing sheet for pharmacists and pharmacy staff.

Please do share the briefing sheet with your colleagues and ensure that everyone  is up to speed on the campaign.

Download briefing sheet for pharmacy teams

Where can I get more information on the Be Clear on Cancer campaigns?

For more information about Be Clear on Cancer, or if you have any queries, please contact partnerships@phe.gov.uk.

*Source: All cancers  excluding non-melanoma skin cancer (C00-C97 excl. C44). Data were provided by  the Office for National Statistics on request, September 2012. Similar data can  be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations

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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