Public Involvement Funds

Project Description

Cancer screening is effective at preventing the onset of cancer and reducing cancer deaths. However, there are widespread inequalities in the uptake of cancer screening. Cervical screening uptake is lower among ethnic minority patients, patients who have a disability (physical, mental or learning), and those who identify as LGBTQ+. There are also differences in uptake based on location with areas experiencing high disadvantage having typically lower uptake rates. This affects all three national screening programmes (cervical, breast and bowel) offered by the NHS. For instance, the percentage of women taking part in cervical screening in Yorkshire has fallen between 2010 and 2018. In 2019 there was a marginal increase but a quarter of women (more than 350,000) are still not regularly attending cervical screening in the region. The Humber, Coast and Vale (HCV) area in Yorkshire and the Humber has a diverse population and varying levels of disadvantage. As an example, recently published Public Health England data show wide variations in cervical screening coverage across the city of Hull, ranging from 48 to 87% of eligible women taking part in 2019/20. This may be due to how disadvantaged different areas are within Hull. There are similar patterns for breast and bowel cancer screening but recent trends show that these programmes seem to be improving.

The COVID-19 pandemic has undoubtedly made cancer prevention more difficult. During the first lockdown, cancer screening was paused in England in April 2020 and resumed in June 2020. This gave mixed messages to the public about the importance of screening. During this period lots of cancer screening appointments were cancelled. Even when the programmes resumed fear of catching the virus has put people off attending medical appointments. This could undermine the last ten years of work to improve screening uptake.

We want to try to improve this situation by offering personal, tailored support to address the concerns and issues that influence whether someone decides to take part in screening. One approach is to use lay health workers (sometimes known as health or community champions, health trainers, or patient navigators) to liaise between individuals and health care services. Research has found that this is effective at increasing cancer screening uptake, particularly among ethnic minority communities. However, most of these studies are from the United States and may not hold true for communities in the UK.

Within Yorkshire, there have been some local initiatives, such as the Wise Up to Cancer project in West Leeds/Wakefield which used members of the public as Community Health Educators. They were found to be approachable, friendly and had the ability to relate to people by showing empathy and making them feel comfortable. They found that the initiative resulted in improved awareness of cancer signs and symptoms but not higher screening uptake. A second project conducted in Bradford with South Asian women showed the benefits of lay health workers, known as Community Champions, helping women to set goals for improving their lifestyle and reducing their cancer risk. They also found that interventions within general practice (text message/phone calls in patient’s first language) were effective at improving cancer screening uptake, especially for cervical screening. These are just a couple of successful examples of similar projects that have used lay health workers to raise cancer awareness and improve screening uptake.

In our study, we want to find out if we can encourage more people living in disadvantaged communities within the HCV area to take part in cancer screening, by working with an existing network of volunteer Cancer Champions. This network is hosted by the HCV Cancer Alliance. This pool of people already has an interest in raising awareness of cancer symptoms and screening. We want their help to deliver information, advice and support on screening issues to people who do not currently take part in screening programmes. We will identify such people by working with local GP practices and the Cancer Champions will make direct contact with them. They will receive full training to carry out this role. Our study will look at whether this approach is practical and effective, both for Cancer Champions and the people they support.