A systematic review of interventions to increase cancer awareness and promote early presentation


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Lindsay Forbes1, Louise Atkins1, Joan Austoker2, Clare Bankhead2, Faith Martin2, Kathryn Robb3, Jane Wardle3, Amanda Ramirez1

1King's College London, UK, 2University of Oxford, UK, 3University College London, UK

Abstract

Background
Low cancer awareness may contribute to delay in presentation for cancer symptoms which may lead to delays in diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research.

Method
We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled trials and uncontrolled studies of interventions delivered to communities.

Results
We found fifteen studies: ten studies of interventions to raise cancer awareness (six individual-level and four community-level interventions) and five studies of community-level interventions to promote early presentation.

We found some evidence from randomised controlled trials that interventions delivered to individuals modestly increase cancer awareness in the short term, and insufficient evidence that they promote early presentation. Tailored written information, especially when reinforced by telephone counselling, was most effective in increasing cancer awareness, with leaflets and computer interactive programmes having more modest effects. All the studies used different and mostly non-standard outcome measures and all except one reported follow-up only to six months.

We found limited evidence from studies of a weaker design (controlled and uncontrolled) that educational programmes and campaigns may lead to diagnosis of cancer at an earlier stage in breast cancer (although this may be due at least partly to increasing uptake of screening), malignant melanoma and retinoblastoma, and reduce delay in presentation in malignant melanoma.

Conclusion
The evidence of effectiveness of interventions to promote cancer awareness and early presentation is limited but encouraging. Future studies should be designed to generate high quality evidence and use standardised, validated outcomes measured over a longer term.