Awareness campaigns and cancer screening.

Abstract

Dame Deborah James, a former deputy head teacher in the UK, raised more than £6·5 million in just over a month for the Cancer Research UK Bowelbabe Fund. Unfortunately, at just 40 years of age, James has also announced that her bowel cancer is terminal. Her courage in these circumstances is admirable. In addition to the money raised, her relentless efforts to improve awareness of bowel cancer, a cancer that is often considered uncomfortable to talk about, and the importance of early diagnosis, are extremely valuable. She is encouraging people to be more aware of the symptoms and to seek help if necessary through her Bowelbabe blog, in newspaper columns, and on her podcast You, Me and the Big C. In recent weeks, mentions of Bowelbabe on Twitter have increased by 8000%, and searches for the terms Bowelbabe and bowel cancer have increased by 280%. In addition, the Cancer Research UK bowel cancer webpages have seen three times more visitors compared with historical view rates. In response to the Deborah James story, Marks and Spencer, in partnership with Bowel Cancer UK, will print the signs and symptoms of colorectal cancer on their toilet roll packaging, and other manufacturers are being urged to follow suit. Deborah James is not the only person in the public eye whose own cancer experience has had a huge impact on the general public. There were notable increases in cervical cancer screening attendance after UK reality TV star Jade Goody's cervical cancer diagnosis in 2008. In 2020, search terms for colorectal cancer increased by 598% and colon cancer screening by 707%, during the first 3 months after the death of the American actor Chadwick Boseman, aged 43, from colon cancer. Similarly, breast cancer screening uptake increased after the death of UK singer Sarah Harding in September, 2021, aged 39, from breast cancer. Breast cancer charities, including The CoppaFeel! Breast cancer charity, reported an increase of more than 800% in people visiting its website following Harding's death. The importance of this increased uptake in early screening is paramount when, according to an National Health Service (NHS) England poll, nearly a third of patients delay visiting their GP because they are worried about receiving bad news or wasting NHS time and resources. In June, 2022, the NHS launched new TV adverts and a social media campaign to encourage people to get checked for cancer and to help allay their fears. A similar campaign that ran in March, 2022, resulted in a 17 times increase in people accessing the NHS website for support compared with February, 2022. To address long waiting lists for health care because of the inevitable COVID-19 backlogs, and to meet the demand for the diagnosis and treatment of conditions including cancer, cardiac, and respiratory disease, the UK Government has pledged to open as many as 160 community diagnostic centres by 2025, although there is much scepticism as to whether this goal is achievable, particularly given budgetary pressures. With around £2·3 billion allocated to expand diagnostics and £1·5 billion for treatment, with a focus on cancer, NHS England hopes to boost its testing capacity to more than 10 million checks over the next 3 years. Patient stories resonate more than most educational campaigns because they humanise issues more effectively, which is important because there is considerable evidence of disparities in cancer screening uptake, and in treatment outcomes, globally. Ethnicity and sexual orientation can influence whether or not people get screened for cancer or take preventive treatments, often because of fears of discrimination and distrust of the health-care system. These disparities in screening diagnosis rates between different ethnic groups were corroborated by a recent study of 243 825 patients with ten different cancers, in which the authors found that Black people are 38% less likely to be diagnosed with cancer via screening than White people, consistent with their lower uptake of screening opportunities. Similarly, research using data from the US National Health Interview Survey found that people with sexual minority status had reduced odds of ever undergoing cervical cancer screening in comparison with heterosexual people, with Hispanic sexual minority participants having the lowest screening uptake. The experiences of patient advocates are valuable in encouraging people to seek medical help, but disparities in uptake and outcomes across different groups of people urgently need to be addressed. Effective outreach and culturally appropriate interventions should be prioritised to reduce health inequalities; moreover, methods of screening need to be made more transparent to reduce unnecessary anxiety, and routes of accessing such services made easier, faster, fairer, and more patient-centric.