Awareness campaigns like 'Be Clear on Cancer' have demonstrable benefit
A rise of 14% of lung cancer diagnoses locally should put an end to cynicism over public health campaigns, argues Dr Ian Watson
Something strange happened just over a year ago. I started being spotted on the Tube when I was down in London, and my patients started bringing in cuttings from newspaper adverts in which I featured. My 15 minutes of fame had come as one of the GPs fronting a campaign from Be Clear on Cancer to drive earlier diagnoses of lung cancer.
The campaign aimed to raise awareness that a cough that lasts for three weeks or more could be a sign of lung cancer and called on patients to visit their GP if they experienced symptoms. It was targeted at men and women aged over 50 – the age group most likely to be diagnosed with lung cancer – and particularly at those from lower-socioeconomic groups, who are often more reluctant to visit their GP.
Lung cancer has one of the lowest survival rates of any cancer, with around 28,100 people dying from the disease each year in England. It’s the biggest cancer killer in this country. Yet there is hope. If our survival rates were as good as the best in Europe, it is estimated that we could save 1,300 additional lives per year. One of the main ways to push up survival rates is to diagnose the disease earlier by supporting people to recognise the early symptoms and visit their doctor if they have them.
The campaign came in for a bit of criticism from some GPs when it initially launched last year. There were concerns that we’d be sending the worried well into surgery, that by using a persistent three-week cough as an indicator, anyone with a seasonal cough might start to think they had lung cancer.
But GPs weren’t inundated with patients. During the regional pilot in October-November 2011, on average only an additional 2.4 patients presented with relevant symptoms per practice per week.
And the cough is a key indicator - more than 90% of patients with lung cancer are symptomatic at diagnosis, with a cough being the most common presenting symptom. The persistent three-week cough message comes from NICE guidelines that state that it is a potential symptom that ‘requires urgent referral for a chest X-ray’.
In fact, the results from last year’s national campaign are strong. The campaign drove awareness amongst the target audience that a cough could be an indicator, with spontaneous awareness of a cough/hoarseness increasing from 41% to 50%. They also show an increase of approximately 30% in two week wait referrals for suspected lung cancer in the campaign months, compared to the same period in the previous year, with the majority of referrals in the over-50s.
The full evaluation of the first national lung campaign will include analysis of the number of cancers diagnosed and stage of diagnosis, but findings from the regional lung pilot are encouraging. For example, trusts in the campaign area saw a 14% increase in lung cancer cases diagnosed in the campaign period compared with a year earlier.1 These trusts also saw a statistically significant increase in small cell cancers staged as ‘limited’ and a positive trend towards earlier diagnosis of non-small cell cancers – neither of these findings were seen in controls. There was also a significant increase in the proportion of patients undergoing potentially curative surgery - and all of this started with their GP.
This July sees the Be Clear on Cancer lung cancer symptom awareness advertising hit our screens and radios once again, until mid-August. The campaign will again tell people what to look out for, and what to do if they spot the symptoms. So, as well as getting used to making eye contact with people on the Tube once again, I’ll be talking about the campaign as widely as possible and encouraging those who might have the early signs of lung cancer to come in to surgery sooner rather than later.
Dr Ian Watson is a GP in Oldham, Associate Medical Director at Pennine Care NHS Foundation Trust and Chair of Primary Care Oldham LLP
For more information on the Be Clear on Cancer lung cancer campaign, visit www.naedi.org/beclearoncancer/lung
1 Department of Health. Outcomes Strategy: A Strategy for Cancer, Second Annual Report. 2012.