Introduction The “Be Clear on Cancer” campaign was launched by Public Health England to raise awareness of gastro-oesophageal cancers, and ran for four weeks from January to February 2015.1 The key message advertised on television was: ‘Having heartburn, most days, for 3 weeks or more, could be a sign of cancer – tell your doctor.’ We aimed to measure how this campaign affected the following: 1) 2 WW gastroscopy referrals, 2) incidence of target diagnoses (Barrett’s and gastro-oesophageal cancer, 3) stage of cancers at diagnosis, 4) cancer survival.
Methods We performed a retrospective study using pooled data from 2 NHS trusts (Royal Wolverhampton and Dudley Group NHS Trust), with a combined population of 699000 in 2014 and 798000 in 2015. Patients referred for 2 WW open access endoscopy for 3 months after campaign start (Feb to April 2015) were identified from Trust clinical databases. Diagnoses, endoscopy, staging, and 9 month survival were compared with data from corresponding months in 2014. Analyses were performed using Fisher’s exact and t-test.
Results 832 referrals were received in the 3 months of 2015, compared with 519 in 2014. After adjusting for population, 2 WW endoscopy demand had increased by 40.4% (p < 0.03). 63 cases of Barrett’s and carcinoma were diagnosed in 2015, compared with 50 cases in 2015. Overall, there was 10.4% increase in detection of significant diagnoses (p = 0.6). 23 cases of oesophageal malignancy were detected, compared with 19 in 2014. The incidence of gastro-oesophageal cancer was 11.5 per 100,000 in 2015, compared with 10.8 per 100,000 population in 2014 (relative increase of 6%, p = 0.85). Due to the increase in gastroscopies performed, the yield of significant diagnoses fell from 8.0% in 2014 to 6.7% in 2015. 8/20 patients had presented with T2 or earlier stage of oesophageal cancer, compared with 3/16 in 2014 (odds ratio 2.9 for ≤T2 disease, p = 0.28). 8/20 had localised disease (N0 and M0) in 2015, with 6/18 in 2014 (OR 1.33 for localised disease, p = 0.74). The unadjusted 9 month mortality rates were 38% (10/28) in 2015 and 52% (12/23) (OR for 9 month survival in 2015 was 0.57, p = 0.39).
Conclusion The “Be Clear on Cancer” campaign significantly increased the demand for 2 WW gastroscopies. A trend towards a higher incidence of Barrett’s or cancer diagnosis was noted, although the overall yield of endoscopy procedures was lower. The odds ratios appear promising for diagnostic yield, earlier presentation and 9 month survival but this was not statistically significant. Larger studies are required to validate our findings.
Reference 1 https://www.england.nhs.uk/wp-content/uploads/2014/09/bcoc-tri-partite-lett-0914.pdf (accessed 25/2/16).
Disclosure of Interest None Declared