Do we need to move beyond Cancer Awareness Campaigns?

For decades governments and charities have launched public health campaigns warning us about our weight, teaching us about the symptoms of cancer and encouraging us to stop smoking. Millions of pounds have been spent on raising public awareness on wellbeing, but are they working?

The simple answer is yes. Such campaigns educate people about symptoms of potentially life threatening illnesses and reassuringly there is evidence that more people go to the doctor following these campaigns. But are they reaching the people at greatest risk?

November is National Lung Cancer Month. Lung cancer is the UK’s biggest cancer killer, and lung cancer deaths are more common in people living in the most deprived areas.

Public Health England has been running a Be Clear on Cancer Campaign focusing on symptoms of persistent cough and inappropriate breathlessness. The campaign is aimed at all men and women aged 50 and over, and encourages people with relevant symptoms to see their GP without delay.

The thinking behind the campaign is that if people know what the warning signs of lung cancer are, they will be more likely to seek help from a doctor promptly, and more likely to be diagnosed at an earlier stage. If lung cancer is caught early, 70 per cent of people will survive for at least 1 year, but this drops to 14 per cent for those diagnosed at a late stage.

Such startling statistics show how important it is to get a lung cancer diagnosis as quickly as possible and highlights the need to find more effective ways to get people to doctors’ surgeries once they start experiencing symptoms.

Public health campaigns are one way to do this but they have limited success. Research published in the British Journal of Cancer suggests that a national lung cancer campaign in 2012 led to a greater increase in GP attendances for practices in less deprived areas but not in more deprived areas.

It’s unclear why such messages are not reaching this key audience – but awareness is only one factor in a vast array of factors influencing whether people a) interpret their symptoms as serious and b) contact a doctor. For example, in the UK we are more worried about wasting the doctor’s time than people living in other international countries with similar healthcare systems (e.g. Canada, Sweden) and this can stop people seeking medical help when they need it.

We can also learn something from our recent work in breast cancer, which has shown important educational differences in how women make sense of breast cancer symptoms. Women from lower educational backgrounds lacked confidence in interpreting their symptoms and seeking help compared to women from higher educational backgrounds. The bottom line is that knowledge alone may not explain inequalities in how people respond to cancer symptoms- because although less educated women ‘knew’ that symptoms could relate to cancer, they gave ‘reasons’ not to react. For example, they were ‘too busy’ due to work and childcare or too frightened.

Much more work is needed to understand inequalities in how people interpret and respond to symptoms. We also need to explore why campaigns may not be reaching those at greatest risk. Recognising that promoting symptom awareness is only one avenue to promoting earlier diagnosis is an important step on this journey.

Dr Katriina Whitaker