The Importance of Early Detection of Cancers

1. The Importance of Early Detection of Cancers Teaching Presentation

2. Areas covered: • National vision • Incidence, mortality and survival in Greater Manchester & Cheshire Cancer Network • The Awareness & Early Diagnosis Initiative • Awareness Campaigns

3. The National Vision “Our aspiration is that England should achieve cancer outcomes which are comparable with the best in the world” “We believe that by 2014/15, 5000 additional lives can be saved each year. It is now for the NHS, working with Public Health England to deliver this ambition” On average a Clinical Commissioning Group serving 200,000 population would save 40 lives p.a. if our survival rates matched those in Australia, Sweden or Canada

4. Avoidable deaths pa if survival in England matched the best in Europe

5. GMCCN Challenge GMCCN Cancer Incidence = >England and rising Ageing population, unhealthy lifestyles GMCCN Survival - Increasing Much of the improved survival as a result of improved secondary care services 1yr survival gap persists GMCCN Mortality - Falling Inequalities exist in terms of access to: Services e.g. screening etc Treatment e.g. older people etc GMCCN contribution to Government ambition in Cancer Strategy To save an additional 546 lives p.a. by 2014/15

6. GMCCN – cancer incidence

7. GMCCN – cancer mortality

8. BREAST CANCER 5 YR R.S. OVARIAN CANCER 5 YR R.S. LUNG CANCER 5 YR R.S. COLORECTAL CANCER 5 YR R.S. SWE AUS CAN CAN NOR AUS AUS CAN DEN SWE CAN UK SWE NOR NOR NOR AUS DEN UK DEN UK DEN UK

9. Reasons for late diagnosis • Patient reasons • Primary care reasons • Secondary care reasons

10. What do you think the patient reasons are for late delay?

11. Reasons for late diagnosis • Patient reasons • Uptake of screening programmes • Awareness of signs and symptoms • Negative beliefs about cancer • Reporting to Primary Care • Primary care reasons • Secondary care reasons

12. What do you think the primary care reasons are for late delay?

13. Reasons for late diagnosis • Patient reasons • Primary care reasons • Access to Primary Care • Recognition of suspicious symptom pattern • Access to Primary Care diagnostics • Use of correct referral pathway i.e. 2WW • Budgetary pressures / reluctance to refer • Secondary care reasons

14. What do you think the secondary care reasons are for late delay?

15. Reasons for late diagnosis • Patient reasons • Primary care reasons • Secondary care reasons • 2WW fast track referral system • 62 day referral to definitive treatment target

16. How will we save 5000 lives p.a.? • Prevention – smoking, obesity, alcohol and lifestyle • Screening – breast, cervical, bowel • Breast: continue age extension (47-73) with randomisation • Cervix: Introduce HPV ‘triage’ for borderline cases • Bowel • Continue extension of FOBT to age 75 • Pilot flexible sigmoidoscopy at age 55 • Reducing premature mortality • Supporting GPs to investigate/refer appropriately • Providing better access to diagnostics

17. The NAEDI Pathway Changing public attitudes, reducing primary care delay, improving access to diagnostics and working on the interface between primary and secondary care are all key elementsreducing delays in diagnosis. • Low public awareness and/or negative beliefs about cancer • Late presentation to GPs • Delays in primary care (awareness/ attitudes/access to diagnostics) • Late referral to hospital • Delays in secondary care • More advanced disease at diagnosis • Poor survival rates • Avoidable deaths

18. Local Awareness & Early Detection Initiative (LAEDI) Cancer Awareness & Early Detection Raising public awareness and promoting earlier presentation Supporting GPs to assess, investigate and refer appropriately Providing better access to diagnostics Chest x-ray – lung Non obstetric ultrasound (ovarian); Flexi sigmoidoscopy / colonoscopy (colorectal cancer); MRI (brain) 4. Address inequalities (access and treatment)

19. GMCCN social marketing campaign, May-Aug 2011 • Core elements were: • Social marketing activity to two audiences • Mainstream white British • South Asian – tailored campaign • developed for this audience: ‘Detect Cancer Early’ • ‘Cancer Champion’ training • Clinical engagement especially with Primary Care • Evaluation

20. Mainstream Advertising

21. Mainstream Posters Above left to right: breast cancer poster, bowel cancer poster and lung cancer poster.

22. CAM+ pre and post survey 22 • Two in five (40%) have seen, read or heard something from the campaign • A quarter (26%) have seen at least one of the posters/leaflets • A third say they saw the campaign materials in their local GP surgery, and a quarter saw it on the side of a bus • A third (33%) have heard one of the radio ads. The most likely sources are Smooth radio and Key 103 • 46 per cent of South Asian people recognise something from the campaign targeted at them • A GP surgery is the most likely source • A third of South Asians have seen the bowel and breast ads on TV, and most either saw them on Channel i or on DM Digital • Most people think it’s important that campaign materials like this are shown, and that they are clear/easy to understand. ¾’s say the campaign would make them more likely to go to their GP if they had symptoms and felt concerned • Agreement is higher among those who recall the campaign • Raising awareness of cancer signs, encouraging people to go to their doctor, and getting checked out for symptoms are recalled as the main top-of-mind messages from the campaign • 4 per cent made an appointment to talk to their GP as result of seeing the campaign • Seven people in ten say they feel confident about noticing signs or symptoms of bowel, breast, or lung cancer. Campaign recognisers are more likely to be ‘very’ confident

23. Be clear on cancer