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Background: Early recognition of symptoms of colorectal cancer enables prompt help-seeking and timely diagnosis that may save lives. We aimed to assess public awareness of symptoms of colorectal cancer, anticipated delay to help-seeking in relation to these symptoms, and knowledge of risk factors and most common types of cancer in the English population. Methods: Cross-sectional surveys (n = 38,630), using the first validated measure of public cancer awareness—the Cancer Research UK Cancer Awareness Measure (CAM), were carried out in England during 2009/11. We examined the association of cancer symptom awareness, knowledge of risk factors for colorectal cancer and anticipated time to help-seeking with age, gender, marital status, educational attainment and socio-economic position. Data were analysed using Kruskal-Wallis tests and logistic regression models. Results: Knowledge that colorectal cancer is the third most common type of cancer in men and women was poor, as only about 10% of participants were aware of this fact. Almost half of participants could not recall any symptom of (46%) or any risk factor (44%) for colorectal cancer. Participants who least frequently recalled and recognised the four cancer symptoms were men, the youngest, the socio-economically deprived, unemployed and single participants. Over a third of participants reported that they would delay help-seeking for more than 2 weeks for “unexplained weight loss” (38%), but only 5% reported this for “unexplained bleeding”. The elderly, the underprivileged and participants without a degree least frequently recognised risk factors, especially “eating red or processed meat each day” and “eating less than 5 of fruit and vegetables a day”. Conclusions: Future campaigns should focus on increasing awareness about symptoms and risk factors of colorectal cancer, and ensuring that people know how common this cancer is. Further efforts are needed to encourage early presentation, particularly among population su

Background: Understanding what influences people to seek help can inform interventions to promote earlier diagnosis of cancer, and ultimately better cancer survival. We aimed to examine relationships between negative cancer beliefs, recognition of cancer symptoms and how long people think they would take to go to the doctor with possible cancer symptoms (anticipated patient intervals). Methods: Telephone interviews of 20,814 individuals (50+) in the United Kingdom, Australia, Canada, Denmark, Norway and Sweden were carried out using the Awareness and Beliefs about Cancer Measure (ABC). ABC included items on cancer beliefs, recognition of cancer symptoms and anticipated time to help-seeking for cough and rectal bleeding. The anticipated time to help-seeking was dichotomised as over one month for persistent cough and over one week for rectal bleeding. Results: Not recognising persistent cough/hoarseness and unexplained bleeding as cancer symptoms increased the likelihood of a longer anticipated patient interval for persistent cough (OR=1.66; 95%CI=1.47-1.87) and rectal bleeding (OR=1.90; 95%CI=1.58-2.30), respectively. Endorsing four or more out of six negative beliefs about cancer increased the likelihood of longer anticipated patient intervals for persistent cough and rectal bleeding (OR=2.18; 95%CI=1.71-2.78 and OR=1.97; 95%CI=1.51-2.57). Many negative beliefs about cancer moderated the relationship between not recognising unexplained bleeding as a cancer symptom and longer anticipated patient interval for rectal bleeding (p=0.005). CONCLUSIONS: Intervention studies should address both negative beliefs about cancer and knowledge of symptoms to optimise the effect.

Background: The incidence of melanoma is rising. Early detection is associated with a more favourable outcome. The factors that influence the timing of a patient’s presentation for medical assessment are not fully understood. The aims of the study were to measure the nature and duration of melanoma symptoms in a group of patients diagnosed with melanoma within the preceding 18 months and to identify the symptoms and barriers associated with a delay in presentation. Methods: A questionnaire was distributed to a random sample of 200 of the 963 melanoma patients who had participated in the Cancer Patient Experience Survey 2010 and were known to be alive 1 year later. Data were collected on symptoms, duration of symptoms prior to presentation and the reasons for not attending a doctor sooner. Results: A total of 159 patients responded to the questionnaire; 74 (47%) were men; mean age was 62 (range 24–90) years. Of the 149 patients who reported a symptom, 40 (27%) had a delayed presentation (i.e. >3 months). A mole growing bigger was the most common symptom and reporting this symptom was significantly associated with a delayed presentation (odds ratio (OR) 2.04, 95% confidence interval (95% CI) 1.14–5.08). Patients aged ≥65 years were less likely to report a barrier to presentation and were less likely to delay than those under 40, although this was of borderline statistical significance (OR 0.28, 95% CI 0.08–1.00). Conclusions: This study highlights that an enlarging mole is a significant symptom influencing the timing of presentation. Increasing public awareness of the signs of melanoma and of the importance of early presentation is desirable. Health professionals should take advantage of the opportunity to educate patients on such symptoms and signs where feasible. Further exploration of the barriers to presentation in younger people should be considered.

BACKGROUND: Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England. METHODS: From population-based surveys (n=35?308), using the Cancer Research UK Cancer Awareness Measure, we calculated the age- and sex-standardised symptom awareness and barriers scores for 52 primary care trusts (PCTs). These measures were evaluated in relation to the sex-, age-, and type of cancer-standardised cancer survival index of the corresponding PCT, from the National Cancer Registry, using linear regression. Breast, lung, and bowel cancer survival were analysed separately. RESULTS: Cancer symptom awareness and barriers scores varied greatly between geographical regions in England, with the worst scores observed in socioeconomically deprived parts of East London. Low cancer awareness score was associated with poor cancer survival at PCT level (estimated slope=1.56, 95% CI: 0.56; 2.57). The barriers score was not associated with overall cancer survival, but it was associated with breast cancer survival (estimated slope=-0.66, 95% CI: -1.20; -0.11). Specific barriers, such as embarrassment and difficulties in arranging transport to the doctor's surgery, were associated with worse breast cancer survival. CONCLUSIONS: Cancer symptom awareness and cancer survival are associated. Campaigns should focus on improving awareness about cancer symptoms, especially in socioeconomically deprived areas. Efforts should be made to alleviate barriers to seeking medical help in women with symptoms of breast cancer.British Journal of Cancer advance online publication 18 August 2016; doi:10.1038/bjc.2016.246 www.bjcancer.com.

Objective In a randomized controlled trial, the Promoting Early Presentation intervention increased older women’s breast cancer awareness after two years. We investigated whether this increase was sustained at three years, and the effect on breast screening self-referral. Methods We randomly allocated 867 women attending their final invited breast screening appointment to the Promoting Early Presentation intervention or usual care. We examined breast cancer awareness after three years and breast screening self-referrals after four years. Results Women in the Promoting Early Presentation intervention arm had higher breast cancer awareness at three years than the usual care arm (odds ratio: 10.4; 95% confidence interval: 3.1 to 34.8). There were no differences in proportions self-referring for breast screening between arms, but statistical power was limited. Conclusion The Promoting Early Presentation intervention has a sustained effect on breast cancer awareness in older women. The effect on self-referral for breast screening is unclear.

Women in the UK have poorer survival rates for breast cancer than many other Western European countries even after taking into account differences in the age distribution of the population. (Berrino et al. 2007). So-called high resolution studies suggest that late stage at diagnosis is largely responsible for the differences in survival rates (Sant et al. 2003). Late stage at diagnosis is almost certainly due to a combination of late presentation by some women and delays in onward referral by some general practitioners. Most delay appears to be due to patient delay (Westcombe et al. 1999), which may be because of late discovery of symptoms or delayed presentation after discovering symptoms. Delay in discovery or presentation with breast symptoms is particularly common in older women. Many clinicians can tell stories about elderly women presenting with apparently unmissable locally advanced breast cancer that must have been causing symptoms for a considerable period of time. While we know that very late presentation is associated with poor prognosis, what is more controversial is the extent to which less prolonged delays (of weeks to months) in presentation influence survival. This is important because at clinical and policy levels, we need to know how strong our message to check for symptoms and present early should be, and how that message should be delivered. The wrong message, delivered to the wrong audience, could lead to breast clinics crowded with the worried well, which would probably have little effect on breast cancer survival. More importantly, it would increase anxiety, unnecessary investigations, and would incur opportunity costs to health services.