Introduction Public Health England (PHE) launched a ‘Be Clear on Cancer campaign on 26th January 2015 encouraging patients with heartburn to see their GP. Our aim was to analyse the impact the ‘Be Clear on Cancer’ campaign had on the number of 2 Week-Wait (2 WW) OGDs performed and the number of cancers detected.
Methods A retrospective analysis of the endoscopy reporting system (HICCS) was undertaken for the 3 months after the launch of the campaign and compared to the same time period across the preceding 3 years. The outcomes considered in this analysis were any cancer of the upper GI tract or Barrett’s Oesophagus.
Results The total number of OGDs (1409) in 2015 was higher than any preceding year, as was the number of 2 WW OGDs (399). The number of cancers fell in 2015 compared to preceding years with only 7 cancers detected on the 2 WW pathway, of which 2 were deemed curable after MDT discussion.
The chance of detecting cancer via a 2 WW OGD fell from 6.9% in 2012 to 1.8% in 2015, with the number needed to scope (NNS) rising from 15.5 patients in 2012 to 57 patients in 2015. The tariff cost of one OGD at the time of the study was £490 leading to an estimated cost per cancer detected of just over £7500 in 2012 rising to just under £28,000 in 2015.
There was an increase in the number of new cases of Barrett’s Oesophagus detected on the 2 WW pathway during the studied period from 9 in 2012 to 19 in 2015.
Barrett’s Oesophagus and cancers detected outside of the 2 WW pathway are also presented in Table 1.
Conclusion The PHE ‘Be Clear on Cancer’ campaign did not detect increased numbers of cancers compared to preceding years despite a large increase in the number of 2 WW OGDs performed in the studied period. Our analysis indicates that purely increasing the number of 2 WW pathway OGDs with the aim of detecting cancer is expensive and resulted in fewer cancers detected.
As the absolute number of cancer cases has decreased despite a 72% increase in number of 2 WW pathway OGDs it is difficult to argue for continuing to increase the number of patients on this pathway without significant modification to the pathway. OGD is not a pleasant test, made worse for the patient by the thought that it may detect a cancer, when in real terms the chance of finding a cancer is relatively small (1.8% in 2015).
Disclosure of Interest None Declared