'Know 4 sure' campaign: Information for practice teams

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Be Clear on Cancer logo for know for sure campaign

Campaign materials

Briefing sheets and marketing materials (leaflets and posters) are available on the resources and tools page.

Download campaign materials

We know that practice managers, receptionists and practice nurses were pivotal in helping to make the ’Know 4 sure’ cancer symptoms pilot campaign a success. We have provided some questions and answers specifically for you to complement other information on this website, and to help you continue to support the campaign.

This section includes general information for practice-based teams. So please encourage your colleagues to take a look.

Be Clear on Cancer is the overarching brand for a programme of work, which aims to improve early diagnosis  of cancer by raising awareness of symptoms and making it easier for people to  discuss them with their GP. Each campaign is tested locally to see how people  respond and what impact it has on their behaviour. The results inform whether  the campaign is taken forward more widely.

In early 2011, the Department of Health ran the successful regional Be Clear  on Cancer bowel cancer pilot – the first test of the Be Clear on Cancer  campaign. Lung cancer then became the focus of a regional pilot in the Midlands, running from 10 October to 13 November 2011. In addition, a number of local  teams ran Be Clear on Cancer activities for breast, bowel and lung in  2010/11.

The Department of Health launched the first national Be Clear on Cancer campaign to raise awareness of bowel cancer signs and symptoms in 2012 – it ran  from January to March; 18 local projects also ran activities to raise awareness of the symptom of blood in urine (for bladder and kidney cancers), breast cancer  in women over 70 and oesophago-gastric cancer; and in May 2012 the lung cancer  campaign rolled out nationally too.

The programme of work continued to develop further. The  national bowel campaign was repeated and local pilots in three areas of  England tested the impact of using different approaches to sustain the  national bowel activity until March 2013. These three pilots covered North London  and North East London; North West England; and Yorkshire TV region.

Regional pilot campaigns ran for ‘blood in pee’ in the North of England  and for breast cancer in women over 70 in the Midlands from 14 January to 17  March 2013; and small scale pilots to test the new campaign focusing on ovarian  cancer and the ‘Know 4 sure’ cancer symptoms campaign took place too.

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 this new Be Clear on Cancer campaign – it was used  in all the adverts and materials.

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)

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.

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 a 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)

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 advertising, for example in local press and on radio, and some included community-based work, such as local events.  These will 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. However, the campaign leaflet also includes other possible symptoms of cancer. The aim is to encourage more people with these symptoms to go and see their GP earlier.

The Be Clear on Cancer campaign targets patients with symptoms, so screening is not mentioned in the posters and adverts – we want to keep the message simple  and direct. The campaign leaflet was tested with GPs and the target audience,  and both felt information on healthy lifestyles was more relevant than screening  information.

But it is a good opportunity to encourage people to take part in breast,  bowel and cervical cancer screening programmes, as appropriate.

If a patient has symptoms, they should see their GP without delay, even if they are waiting for screening or have just recently been screened.

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

You can order hard copies of the cancer leaflets and posters free of charge from  the Department of Health’s orderline or by calling 0300 123 1002.

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

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

The public-facing website for the Be Clear on  Campaign is NHS Choices: www.nhs.uk/know4sure.

1. Brief colleagues. The whole  practice team needs to be aware of this campaign, so they can support it.  There’s a briefing sheet for practice  teams and there’s a separate one for GPs . The campaign may prompt people to discuss symptoms with  your practice nurse as part of other appointments or clinics. So, as well as  GPs, it’s important that practice nurses are aware of the key messages.

It’s vital receptionists are prepared for people who have symptoms wanting  appointments. But, they need to be mindful that they may feel that they’re  wasting the GP’s time.

2. Expect and plan for the  campaign. Share this briefing sheet, and the one for GPs, and make sure  your team knows they’re available. Encourage everyone to continue to look at the campaign web pages on NHS Choices and have a look through the campaign leaflet. Be prepared for an increase in the number of people sent for diagnostic tests and referred via the  urgent two-week wait referral system and, as a result, more people ringing up  asking for test results.

The Department of Health initially piloted the 'Know 4 sure' cancer symptoms campaign on a relatively small scale, so it can assess the impact on  primary and secondary care, and test the feasibility of this approach. You are  likely to see more people coming to your practice with symptoms, but experience  of previous Be Clear on Cancer campaigns suggest that your practice is unlikely  to be overwhelmed.

Analysis following the national Be Clear on Cancer bowel campaign, which ran  from January to March 2012, showed an increase of one patient with relevant  symptoms per practice every two weeks. That was a national campaign, which  included TV advertising.

You may see more people coming to your practice with  cancer symptoms as a result of local activities, possibly a few weeks into the  campaign.

3. Advertise. Display posters and leaflets and encourage  colleagues to talk about the campaign. It is often face-to-face discussion that  changes behaviour. Talking might prompt someone to make an appointment or open  up about their symptoms.

There are lots of resources to support practice managers and practice teams,  including National General Practice Profiles with cancer data for  individual practices. One source of support for frontline staff is a free to  access toolkit developed by Lancashire & South Cumbria Cancer Network.

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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