1) Raising awareness of cancer isn’t working

Each year there are around 140 health awareness days, weeks or months across the UK. Usually, there are none in August and December so, on average, there are about fourteen per month. Quite a few are for cancer and most are driven by the nationally active voluntary sector. Some you notice, some you don’t.

March is Prostate Cancer Awareness Month, Ovarian Cancer Awareness Month and Brain Tumour Awareness Month, which may or may not be related to Brain Awareness Week which is for neuroscience, not cancer. April is a quieter month for cancer as only bowel cancer looms. Lymphatic Cancer Week occurs in May as does Cancer Prevention Week. And so it goes on, a great deal of activity. But is it effective? And by what criteria?
 
In November last year the Department of Health published a baseline report on public awareness of cancer, giving the results from two national surveys using the CR-UK Cancer Awareness Measure (CAM). The CAM was developed as part of the National Awareness and Early Diagnosis Initiative (NAEDI) part of implementing the Cancer Reform Strategy. The CAM surveys benchmarked current levels of national cancer awareness, to provide a baseline against which to identify progress on awareness of symptoms and risk factors. The results were disappointing. They were exactly the same on risk factors as those from a similar study eight years earlier. Nothing had changed in that time. All those cancer charity websites, all those campaigns, news stories, case studies and leaflets and the public still have poor awareness of established risk factors. There is no reason to suppose symptom recognition has improved over the decade either.
 
Beyond any doubt, national tumour specific cancer charities are vital. Every one of the 300,000 men, women and children landed with a cancer diagnosis each year deserves all the information, support and research funds committed to their particular cancer that any cancer charity can offer.
 
However, in the light of these poor awareness results it is time for a critical look at how national cancer charities can improve and  organise awareness raising of cancer risk factors and symptoms.
 
Cancer ‘awareness’ could save many lives and has the greatest buy in from policymakers. Some of the factors that increase the risk of cancer are modifiable, so adopting various recommended changes in behaviour should prevent many cancers. Clearly, being made aware of these factors is the first step. Other factors are not modifiable - age, or family history for example -  but ‘awareness’ by the individual that these could be an issue for them may promote a timely visit to a GP when symptoms occur. Lifestyle related cancers, which make up about 40% of cancers come out of this analysis with clear content for awareness raising campaigns and ‘calls to action’.
 
However, muddle and ambiguity start here. Not all cancers are amenable to behaviour change or have any symptoms that occur early enough to enable life saving early intervention. Three cancers make up just over half of all cancers diagnosed in men - colorectal, lung and prostate - and in women - colorectal, lung and breast. All the rest are rarer and there is no clarity on how to address awareness of those honestly, where sheer bad luck explains the diagnosis without confusing the public, or appearing to dismiss or blame the men and women diagnosed with them. Children and adolescents have their own particular issues – because cancer is very rare at that age, so awareness raising on symptoms is far from straight forward and probably needs directing at GPs too.
 
These single tumour site charities have to find their place elsewhere on a much less well defined ‘awareness’ platform - by emphasising the need for research funds and defining that as ‘raising awareness’, or calling for improved services, and defining that as raising awareness. Even events that are entirely for fundraising can be deemed awareness raising. Some cancer charities may cling by their fingertips to the orthodoxy of awareness of symptoms and risk factors because that is a sector norm, gives some illusion of ‘empowerment’ and it is what the media likes to use in any coverage. Media coverage is most cancer charities’ ambition.  Some cancer charities follow a scattergun ‘awareness’ strategy that works across all these agendas, though usually tackling only one area at a time. 
 
So what are the national tumour specific cancer charities doing wrong in awareness raising and can they put it right?