Explore the vast range of titles available.

Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.

BackgroundChanging population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.MethodsPopulation attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.ResultsNearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.ConclusionTobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.

The accessibility of open data means that ever more information is available, and it is important that the public and policy makers are able to make sense of it. Cancer Research UK developed an interactive website that places cancer data in a local context. The aim is to support decision makers and health professionals by highlighting areas for improvement at a local level. In addition to the interactive website, more in-depth analysis of general practice statistics provides general practitioners with better contextualisation of their local population. The interactive website compiles publicly available local data for epidemiology, risk factors, and early diagnosis from a range of sources. Locations can be compared with the national average and with other areas on the basis of statistically significant differences. Local area statistics are also matched to parliamentary constituencies to engage policy makers. Data are converted to intelligence with recommended actions and presented by means of infographics. In addition, to support general practitioners, regression analysis of screening coverage data for general practices linked to practice demographic data provided a model to predict the expected screening coverage. Local statistics show variation in risk factor prevalence and hence cancer burden and outcomes. These data inform evidence-based discussions with politicians as demonstrated by Members of Parliament referencing our analyses during parliamentary debates and in constituency press releases. Our user surveys indicate that 70% of health professionals using the interative website found the content relevant. Modelling of screening data shows that variation in screening coverage across general practices is explained to varying degrees by several patient population characteristics. The difference between the expected and actual coverage identified whether each practice achieved a higher or lower screening coverage than predicted. Users found the results helpful as demonstrated by requests for additional analysis and further partnership working. This web resource enables local variations in data to be explored, highlighting the challenges and opportunities for improving outcomes locally, helping to raise cancer awareness, and identifying where action needs to be taken to reduce inequalities. Modelling results communicated with general practitioners face-to-face provides an improved indication of practice screening performance, and supports them in improving early diagnosis. None.

Smoking is a major public health problem. As smokers age and die prematurely, the tobacco industry must continue to recruit new, young smokers. Survey data indicate that currently in the UK around 207 000 children aged 11–15 start smoking every year. We used local data on adult smoking rates to apportion national data on child smoking uptake to specific areas. The presentation of data for individual local authorities, which now have responsibility for public health, can be used to focus attention locally. For example, this analysis demonstrates that each day, 67 children, more than two classrooms full, start smoking in London.

This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data (N=205,541 invitees aged 60–74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (P=0.68). In 60–69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%, OR=1.07, P=0.047). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%, OR=1.09, P=0.027). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%, OR=1.28, P<0.001). The increased uptake in the intervention groups was largest in “first-timers” and smaller amongst previous nonresponders and previously screened invitees.

IntroductionRobust evidence on the benefits and harms of breast density notification is required to inform current and future mammography screening policy and practice. This randomised controlled trial (RCT) aims to assess the effect of notifying women with dense breasts of their breast density on their psychosocial outcomes and health services use; and to determine whether using different modes of communication alters these effects.MethodsCo-designed with breast screening services and consumers in Australia to address key national evidence gaps and priorities. Weekly meetings with partners, local consumers and practitioners, led to the design of the intervention and implementation of prospective 3-arm RCT: standard care (no notification of breast density) vs. notification of breast density plus a hard-copy written health literacy sensitive information vs. notification of breast density plus a link to online video-based health literacy sensitive information. Women (n=2856) attending population-based mammography screening classified as having dense breasts (BI-RADS density C and D) randomised. Primary outcome measures include psychological and health service use. Baseline demographic screening data and self-report data collected from women over a >2-year follow-up period (8–10- week, 12- and 27-month timepoints). A longitudinal qualitative sub-study (n=60) conducted at the three timepoints.ResultsRecruitment and initial 8–10 week data collection is underway. The protocol for this co- designed RCT, and descriptive data, participation rates and preliminary 8–10 week data will be presented.DiscussionThis is the first service-embedded RCT in Australia and the world to test the immediate and downstream impact of breast density notification on women and health services prior to systemic implementation. This evidence will help minimise potential harms and map out consequences of widespread breast density notification.ConclusionFindings will directly inform Australia’s current and future policy and practice on this controversial issue, and may be relevant to screening programs in other countries.

ObjectivesRobust evidence on the benefits and harms of breast density notification is required to inform future mammography screening policy and practice. This randomised controlled trial (RCT) aims to assess the effect of notifying women with dense breasts participating in population-based breast cancer screening in Australia of their breast density on their psychosocial outcomes and health services use; and to determine whether using different modes of communication alters these effects.MethodCo-designed prospective 3-arm RCT: standard care (no notification of breast density) vs. notification of breast density plus a hard-copy written health literacy sensitive information vs. notification of breast density plus a link to online written and video-based health literacy sensitive information. Women attending for mammography screening, at a single service with multiple sites in Queensland Australia, who are classified as having dense breasts (BI-RADS density C and D) will be randomised. Primary outcome measures will be psychological and health service use. Secondary outcome measures will be cancer worry, perceived risk, breast density knowledge, future mammogram screening, and acceptability. Baseline demographic screening data will be collected, and self-report data will be collected from women over a >2-year follow-up period (8-10-week, 12- and 27-month timepoints).ResultsThe trial has been registered in the Australian New Zealand Clinical Trials Registry ACTRN12623000001695p and ethics has been approved by the Gold Coast Hospital and Health Service Ethics Committee: HREC/2023/QGC/89770. Trial findings will be disseminated through publications and presentations in national and international peer-reviewed journals and conferences, and reports to relevant government, cancer, and screening stakeholders.ConclusionsThis will be the first service-embedded RCT in Australia and the world to test the immediate and downstream impact of breast density notification on women and health services prior to systemic implementation. It will provide evidence to help minimise potential harms including overdiagnosis and map out consequences. Findings will inform Australia’s current and future policy and practice on this controversial issue and may be relevant to screening programs in other countries.