CANCER PREVENTION AND AETIOLOGICAL RISK FACTORS Abstract O-01
Abstract O-02
Oral statin use associated with reduced risk of monoclonal gammopathy of undetermined significance and multiple myeloma: a population-based nested case-control study
Dietary magnesium, calcium:magnesium ratio and risk of reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma
1
1
1
Charlene M. McShane , Christopher Tapper , Liam J. Murray , Ola Landgren2, Marie C. Bradley3, Carmel M. Hughes4, Lesley A. Anderson1 1 Centre for Public Health, Queen’s University Belfast 2 Memorial Sloan-Kettering Cancer Center 3 Cancer Prevention Fellowship Program, National Cancer Institute 4 School of Pharmacy, Queen’s University Belfast Background: Several studies have suggested statin-mediated inhibition of the mevalonate pathway is tumour-suppressive, with a pronounced effect in haematological malignancies reported. To date, there have been few investigations of the associations between statin use and the plasma cell disorders including monoclonal gammopathy of undetermined significance (MGUS) the premalignant precursor to multiple myeloma (MM). The aim of this study was to investigate the association between antecedent oral statin use and subsequent risk of MGUS and MM. Method: Using the UK Clinical Practice Research Datalink (CPRD), a nested case-control study was undertaken. Conditional logistic regression models were used to estimate odds ratios (OR) and associated 95% Confidence Intervals (Cl) excluding 12 months prior to MGUS/MM diagnosis. Findings were adjusted for a number of potential confounders including age at diagnosis, comorbidities, prior cancer, number of GP consultations and lifestyle variables. Results: In total, 4,654 MGUS and 3,801 MM patients matched to 23,101 and 18,991 controls respectively were identified. In adjusted analyses, statin users were found to have a 16% reduced risk of developing MGUS (OR 0.84, 95% CI 0.78–0.91) and a 24% reduced risk of developing MM (OR 0.76, 95% CI 0.68–0.84). Conclusions: In this large population-based study, statin usage was associated with a reduced risk of developing both MGUS and MM. The greater protective effect observed with MM, suggests statins may play a role in preventing progression of MGUS to MM or associated lymphoproliferative malignancies. As a well-tolerated drug class with limited safety concerns, statins if proven to be effective anti-MM agents have the potential to reduce MM burden worldwide with limited financial impact to healthcare systems and/or risk to patients. Further investigation and clinical trials are however needed to confirm this.
Qi Dai1, Marie Cantwell2, Liam Murray2, Wei Zheng1, Lesley Anderson2, Helen Coleman2 1 Vanderbilt Epidemiology Center, Vanderbilt University 2 Centre for Public Health, Queen’s University Belfast Background: Recent evidence suggests a role for magnesium, and the ratio of calcium to magnesium, intakes in the prevention of colonic carcinogenesis. However, the association between these nutrients and oesophageal adenocarcinoma, a tumour with increasing incidence in developed countries and poor survival rates, has yet to be explored. The aim of this investigation was to explore the association between magnesium intake and related nutrients and risk of oesophageal adenocarcinoma and its pre-cursor conditions, Barrett’s oesophagus and reflux oesophagitis. Methods: This analysis included cases of oesophageal adenocarcinoma (n = 218), Barrett’s oesophagus (n = 212), reflux esophagitis (n = 208) and population-based controls (n = 252) recruited between 2002 and 2005 throughout the island of Ireland. All subjects completed a 101-item food frequency questionnaire. Unconditional logistic regression analysis was applied to determine odds of disease according to dietary intakes of magnesium, calcium and resulting calcium:magnesium ratio. Results: After adjustment for potential confounders, individuals consuming the highest magnesium intakes from foods had significant reductions in the odds of reflux oesophagitis (OR 0.31, 95% CI: 0.11–0.87) and Barrett’s oesophagus (OR 0.29, 95% CI: 0.12–0.71) compared with individuals consuming the lowest magnesium intakes. The protective effect of magnesium was more apparent in the context of a low calcium:magnesium intake ratio. No significant associations were observed for magnesium intake and oesophageal adenocarcinoma risk (OR 0.77, 95% CI: 0.30–1.99 comparing the highest and lowest tertiles of consumption). Conclusions: In conclusion, dietary magnesium intakes were inversely associated with reflux oesophagitis and Barrett’s oesophagus risk in this Irish population, suggesting a chemopreventive role for magnesium in the earlier stages of the inflammation-metaplasia-adenocarcinoma pathway.
ª 2015 The Authors. European Journal of Cancer Care ª 2015 John Wiley & Sons Ltd Vol 24 (Suppl. 1); June 2015; 1–23
1
Cancer Screening, Early Diagnosis of Cancer
Abstract O-03 Modifiable risk factors for colorectal serrated polyps: a systematic review and meta-analysis Lesley Bailie1, Maurice Loughrey2, Helen Coleman1 1 Centre for Public Health, Queen’s University Belfast 2 Department of Pathology, Belfast Health and Social Care Trust Background: Certain categories within the classification of serrated polyps (SP) of the colorectum are now understood to carry malignant potential. The serrated pathway accounts for at least 15% of all colorectal cancers. The aim of this systematic review was to investigate the association between modifiable lifestyle factors and risk of SP. Methods: A search was conducted systematically within three databases, Medline, Embase and Web of Science, for relevant literature published by October 2014. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were combined using random effects meta-analyses to assess the risk of SP, where possible. Results: Thirty-six papers were identified for inclusion in the review, analysing SP risk and seven different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, nonsteroidal anti-inflammatory drug (NSAID) use and/or infectious agents. When comparing the highest and lowest categories of exposure, significant elevated risks of SP were identified for tobacco smoking (OR 2.78, 95% CI 2.30–3.34); alcohol intake (OR 1.36, 95% CI 1.19–1.56), and body mass index (OR 1.46, 95% CI 1.19–1.79). Contrastingly, significant decreased SP risks were observed for NSAID (OR 0.77, 95% CI 0.63–0.94) and aspirin users (OR 0.77, 95% CI 0.65–0.92), compared with non-users. No significant associations were detected for SP risk and physical activity, while associations with dietary factors were mixed. Most studies had not separately identified sessile serrated adenomas/polyps from hyperplastic polyps in their analyses, as publication predated widespread recognition of this novel serrated polyp category. Conclusion: This systematic review has identified novel associations for several lifestyle factors and risk of SP, subgroups of which have recently been implicated in carcinogenesis. These findings enhance our understanding of potential mechanisms involved, and suggest that SP (and ultimately colorectal cancer) risk could be reduced via changes in lifestyle. Further studies are needed to report on specific SP categories.
CANCER SCREENING, EARLY DIAGNOSIS OF CANCER Abstract O-04 An examination of referral patterns following Be clear on cancer campaigns John Broggio1, Matthew Francis1 1 Public Health England Knowledge & Intelligence Team West Midlands Background: Public Health England, in collaboration with cancer charities and the Department of Health, has run campaigns to raise awareness in the general public and the medical community of (early) “warning signs” of particular cancers. Evaluations have previously studied Cancer Waiting Times data and polling of the general public. The Diagnostic
2
Imaging Datasets (DIDs) were investigated to assess the impact the campaigns have on referrals for suspected cancer. Methods: The number of clinically relevant referrals to the national “Blood in pee” campaign and the national “Lung cancer (first reminder)” campaign were obtained from the Health & Social Care Information Centre’s DIDs stratified by month, diagnostic procedure, Trust of procedure and who (GP or consultant) requested the referral and compared with the campaign periods. Results: A large monthly increase in the number of chest x-ray referrals and lung cancer diagnoses followed the lung cancer campaign for the duration of the campaign and the following 2 months. Referrals for ultrasound and CT scans for suspected lung cancers did not change around the time of the campaign. The lung cancer campaign analysis highlighted potential issues with large scale updates of the DID in a relatively short period of time. A small increase in the number of ultrasound scans followed the kidney and bladder cancer campaigns around the time of the campaign. Relatively high volatility in the number of referrals was found before and after the campaign period. Conclusion: DID has been subject to significant revision in the relatively recent past so caution is required when drawing conclusions from this dataset. The volatility of some metrics means that it is not possible to determine the impact of campaigns in less common cancers. Cancer stage at diagnosis should be analysed to see if changes in the cancer stage at diagnosis varies with the campaign periods.
Abstract O-05 Is there nationwide variation in the proportion of oesophago-gastric cancers diagnosed at an early stage? Georgina Chadwick1, Oliver Groene1,2, David Cromwell1,2 1 Royal College of Surgeons 2 London School of Hygiene and Tropical Medicine Background: 5 year survival for oesophago-gastric cancer is poor, but is closely linked to cancer stage at diagnosis. This study investigates patient characteristics associated with early diagnosis and nationwide variation in the proportion of cancers diagnosed early. Methods: Data comes from the National Oesophago-Gastric Cancer Audit, for patients diagnosed with oesophageal cancer over 2 years in England and Wales (1/4/11–31/3/13). Variations in stage at diagnosis where compared across strategic clinical networks (SCNs). We estimated case-mix adjusted rates of early cancer diagnosis using logistic regression models. Results: 15,638 patients (68.5%) had full staging information. Only 5.4% (n = 837) of cancers were diagnosed at an early stage (T0/1, N0 and M0). The proportion of cancers diagnosed early was significantly associated with a history of Barrett’s oesophagus (9.6% vs 2.0%, P < 0.001), but not with patient’s age, sex, and performance status. Adenocarcinomas were significantly more likely to be diagnosed early compared to squamous cell cancers (5.7% (95% CI 5.3–6.2%) vs 3.8% (95% CI 3.1–4.6%)). After adjusting for age, sex, number of comorbidities and type of cancer, we observed significant variation in the proportion of cancers diagnosed at an early stage across SCNs [(3.1% (95% CI 2.3–4.0%) - 8.6% (95% CI 6.7–10.7%))]. Conclusion: There is substantial nationwide variability in the proportion of cancers diagnosed at an early stage. This needs to be monitored at a Trust level, and investigated where rates are low. Causative factors may reflect the social demographic
ª 2015 The Authors. European Journal of Cancer Care ª 2015 John Wiley & Sons Ltd Vol 24 (Suppl. 1); June 2015; 1–23
Cancer Screening, Early Diagnosis of Cancer
of the local population and recognition of symptoms by the patient, access to GP services for referral for endoscopy, and availability of endoscopy services at the local hospitals. The ‘Be clear on cancer campaign’ aims to address the first of these factors, but SCNs need to take responsibility for the later two.
Abstract O-06 Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers Gary Abel1, Jon Shelton2,3, Sam Johnson3, Lucy Elliss-Brookes3, Yoryos Lyratzopoulos1,3,4 1 Cambridge Centre for Health Services Research, 2 Care Quality Commission Care, 3 National Cancer Intelligence Network, 4 Health Behaviour Research Centre, University College London Although socio-demographic and cancer site variation in risk of cancer diagnosis via emergency presentation has been previously described, relatively little is known about how this risk may vary by sex, age and deprivation group between patients with a given cancer. Data were analysed from the Routes to Diagnosis project on 749,645 patients (2006–10) with any of 27 cancers. Crude proportions and crude and adjusted odds ratios were calculated for Emergency Presentations and interactions between sex, age and deprivation with cancer were examined. The overall proportion of patients diagnosed through Emergency Presentation varied greatly by cancer. Compared with men, women were at greater risk of emergency presentation for bladder, laryngeal, and lung cancer (e.g. bladder cancer specific sex odds ratio 1.50, 95% CI 1.42–1.58), whereas the opposite was true for oral/oro-pharyngeal cancer, lymphomas and melanoma (e.g. oro-pharyngeal cancer specific sex odds ratio 0.49, 95% CI 0.36–0.66). Similarly, younger patients where at higher risk of emergency presentation for acute leukaemias, colon, stomach and oesophageal cancer (e.g. colon cancer specific 35–44 vs. 65–74 year olds odds ratio 2.01, 95% CI 1.81–2.23); and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin’s Lymphoma (e.g. laryngeal cancer specific 35–44 vs. 65–74 year olds odds ratio 0.19, 95% CI 0.05–0.76). Inequalities in risk of emergency presentation by deprivation group were greatest for oral/oro-pharyngeal, anal, laryngeal and small intestine cancers. Among patients with the same cancer, risks of emergency presentation vary notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated with psychosocial processes which can delay seeking of medical help and difficulties in suspecting the diagnosis of cancer after presentation.
Abstract O-07 Increasing uptake in the bowel cancer screening programme with GP participation: the PEARL Project Sally Benton1, Piers Butler1, Katy Reed1, Sally Rickard2, Sally Stanley2, Michelle Chesters2, Richard Roope2, Stephen Halloran1 1 NHS Bowel Cancer Screening Programme - Southern Hub, 2 Wessex Strategic Clinical Network There is wide variation in uptake of bowel cancer screening in England. Areas with a high index of multiple deprivation
(IMD) score (more deprived) have lower uptake than areas with low IMD (less deprived). Initiatives to raise awareness of bowel cancer and screening have been sporadic and have not been sustained. Previous studies have demonstrated endorsement by a general practitioner (GP) can increase uptake of bowel cancer screening. The Bowel Cancer Screening Programme (BCSP) Southern Hub is piloting a sustainable intervention to engage subjects in bowel cancer screening, exploiting GP patient knowledge and the Hub’s established procedures for communication. Participating practices supplied the Hub with a letterhead and GP signature. A computer program was developed to interrogate the BCSP database and identify non-participants (>30 days after standard reminder letter) in these practices The non-participating subject list was emailed to each practice for GPs to identify those not suitable for GP reminder (end-of-life-care, unable to have colonoscopy, etc). The list was returned to the Hub to exclude recent responders. Subjects on the final list received an approved GPendorsed reminder letter on GP-headed and signed stationery. Practices returning three lists received a financial reward. 46 practices with uptake
Abstract O-02
Oral statin use associated with reduced risk of monoclonal gammopathy of undetermined significance and multiple myeloma: a population-based nested case-control study
Dietary magnesium, calcium:magnesium ratio and risk of reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma
1
1
1
Charlene M. McShane , Christopher Tapper , Liam J. Murray , Ola Landgren2, Marie C. Bradley3, Carmel M. Hughes4, Lesley A. Anderson1 1 Centre for Public Health, Queen’s University Belfast 2 Memorial Sloan-Kettering Cancer Center 3 Cancer Prevention Fellowship Program, National Cancer Institute 4 School of Pharmacy, Queen’s University Belfast Background: Several studies have suggested statin-mediated inhibition of the mevalonate pathway is tumour-suppressive, with a pronounced effect in haematological malignancies reported. To date, there have been few investigations of the associations between statin use and the plasma cell disorders including monoclonal gammopathy of undetermined significance (MGUS) the premalignant precursor to multiple myeloma (MM). The aim of this study was to investigate the association between antecedent oral statin use and subsequent risk of MGUS and MM. Method: Using the UK Clinical Practice Research Datalink (CPRD), a nested case-control study was undertaken. Conditional logistic regression models were used to estimate odds ratios (OR) and associated 95% Confidence Intervals (Cl) excluding 12 months prior to MGUS/MM diagnosis. Findings were adjusted for a number of potential confounders including age at diagnosis, comorbidities, prior cancer, number of GP consultations and lifestyle variables. Results: In total, 4,654 MGUS and 3,801 MM patients matched to 23,101 and 18,991 controls respectively were identified. In adjusted analyses, statin users were found to have a 16% reduced risk of developing MGUS (OR 0.84, 95% CI 0.78–0.91) and a 24% reduced risk of developing MM (OR 0.76, 95% CI 0.68–0.84). Conclusions: In this large population-based study, statin usage was associated with a reduced risk of developing both MGUS and MM. The greater protective effect observed with MM, suggests statins may play a role in preventing progression of MGUS to MM or associated lymphoproliferative malignancies. As a well-tolerated drug class with limited safety concerns, statins if proven to be effective anti-MM agents have the potential to reduce MM burden worldwide with limited financial impact to healthcare systems and/or risk to patients. Further investigation and clinical trials are however needed to confirm this.
Qi Dai1, Marie Cantwell2, Liam Murray2, Wei Zheng1, Lesley Anderson2, Helen Coleman2 1 Vanderbilt Epidemiology Center, Vanderbilt University 2 Centre for Public Health, Queen’s University Belfast Background: Recent evidence suggests a role for magnesium, and the ratio of calcium to magnesium, intakes in the prevention of colonic carcinogenesis. However, the association between these nutrients and oesophageal adenocarcinoma, a tumour with increasing incidence in developed countries and poor survival rates, has yet to be explored. The aim of this investigation was to explore the association between magnesium intake and related nutrients and risk of oesophageal adenocarcinoma and its pre-cursor conditions, Barrett’s oesophagus and reflux oesophagitis. Methods: This analysis included cases of oesophageal adenocarcinoma (n = 218), Barrett’s oesophagus (n = 212), reflux esophagitis (n = 208) and population-based controls (n = 252) recruited between 2002 and 2005 throughout the island of Ireland. All subjects completed a 101-item food frequency questionnaire. Unconditional logistic regression analysis was applied to determine odds of disease according to dietary intakes of magnesium, calcium and resulting calcium:magnesium ratio. Results: After adjustment for potential confounders, individuals consuming the highest magnesium intakes from foods had significant reductions in the odds of reflux oesophagitis (OR 0.31, 95% CI: 0.11–0.87) and Barrett’s oesophagus (OR 0.29, 95% CI: 0.12–0.71) compared with individuals consuming the lowest magnesium intakes. The protective effect of magnesium was more apparent in the context of a low calcium:magnesium intake ratio. No significant associations were observed for magnesium intake and oesophageal adenocarcinoma risk (OR 0.77, 95% CI: 0.30–1.99 comparing the highest and lowest tertiles of consumption). Conclusions: In conclusion, dietary magnesium intakes were inversely associated with reflux oesophagitis and Barrett’s oesophagus risk in this Irish population, suggesting a chemopreventive role for magnesium in the earlier stages of the inflammation-metaplasia-adenocarcinoma pathway.
ª 2015 The Authors. European Journal of Cancer Care ª 2015 John Wiley & Sons Ltd Vol 24 (Suppl. 1); June 2015; 1–23
1
Cancer Screening, Early Diagnosis of Cancer
Abstract O-03 Modifiable risk factors for colorectal serrated polyps: a systematic review and meta-analysis Lesley Bailie1, Maurice Loughrey2, Helen Coleman1 1 Centre for Public Health, Queen’s University Belfast 2 Department of Pathology, Belfast Health and Social Care Trust Background: Certain categories within the classification of serrated polyps (SP) of the colorectum are now understood to carry malignant potential. The serrated pathway accounts for at least 15% of all colorectal cancers. The aim of this systematic review was to investigate the association between modifiable lifestyle factors and risk of SP. Methods: A search was conducted systematically within three databases, Medline, Embase and Web of Science, for relevant literature published by October 2014. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were combined using random effects meta-analyses to assess the risk of SP, where possible. Results: Thirty-six papers were identified for inclusion in the review, analysing SP risk and seven different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, nonsteroidal anti-inflammatory drug (NSAID) use and/or infectious agents. When comparing the highest and lowest categories of exposure, significant elevated risks of SP were identified for tobacco smoking (OR 2.78, 95% CI 2.30–3.34); alcohol intake (OR 1.36, 95% CI 1.19–1.56), and body mass index (OR 1.46, 95% CI 1.19–1.79). Contrastingly, significant decreased SP risks were observed for NSAID (OR 0.77, 95% CI 0.63–0.94) and aspirin users (OR 0.77, 95% CI 0.65–0.92), compared with non-users. No significant associations were detected for SP risk and physical activity, while associations with dietary factors were mixed. Most studies had not separately identified sessile serrated adenomas/polyps from hyperplastic polyps in their analyses, as publication predated widespread recognition of this novel serrated polyp category. Conclusion: This systematic review has identified novel associations for several lifestyle factors and risk of SP, subgroups of which have recently been implicated in carcinogenesis. These findings enhance our understanding of potential mechanisms involved, and suggest that SP (and ultimately colorectal cancer) risk could be reduced via changes in lifestyle. Further studies are needed to report on specific SP categories.
CANCER SCREENING, EARLY DIAGNOSIS OF CANCER Abstract O-04 An examination of referral patterns following Be clear on cancer campaigns John Broggio1, Matthew Francis1 1 Public Health England Knowledge & Intelligence Team West Midlands Background: Public Health England, in collaboration with cancer charities and the Department of Health, has run campaigns to raise awareness in the general public and the medical community of (early) “warning signs” of particular cancers. Evaluations have previously studied Cancer Waiting Times data and polling of the general public. The Diagnostic
2
Imaging Datasets (DIDs) were investigated to assess the impact the campaigns have on referrals for suspected cancer. Methods: The number of clinically relevant referrals to the national “Blood in pee” campaign and the national “Lung cancer (first reminder)” campaign were obtained from the Health & Social Care Information Centre’s DIDs stratified by month, diagnostic procedure, Trust of procedure and who (GP or consultant) requested the referral and compared with the campaign periods. Results: A large monthly increase in the number of chest x-ray referrals and lung cancer diagnoses followed the lung cancer campaign for the duration of the campaign and the following 2 months. Referrals for ultrasound and CT scans for suspected lung cancers did not change around the time of the campaign. The lung cancer campaign analysis highlighted potential issues with large scale updates of the DID in a relatively short period of time. A small increase in the number of ultrasound scans followed the kidney and bladder cancer campaigns around the time of the campaign. Relatively high volatility in the number of referrals was found before and after the campaign period. Conclusion: DID has been subject to significant revision in the relatively recent past so caution is required when drawing conclusions from this dataset. The volatility of some metrics means that it is not possible to determine the impact of campaigns in less common cancers. Cancer stage at diagnosis should be analysed to see if changes in the cancer stage at diagnosis varies with the campaign periods.
Abstract O-05 Is there nationwide variation in the proportion of oesophago-gastric cancers diagnosed at an early stage? Georgina Chadwick1, Oliver Groene1,2, David Cromwell1,2 1 Royal College of Surgeons 2 London School of Hygiene and Tropical Medicine Background: 5 year survival for oesophago-gastric cancer is poor, but is closely linked to cancer stage at diagnosis. This study investigates patient characteristics associated with early diagnosis and nationwide variation in the proportion of cancers diagnosed early. Methods: Data comes from the National Oesophago-Gastric Cancer Audit, for patients diagnosed with oesophageal cancer over 2 years in England and Wales (1/4/11–31/3/13). Variations in stage at diagnosis where compared across strategic clinical networks (SCNs). We estimated case-mix adjusted rates of early cancer diagnosis using logistic regression models. Results: 15,638 patients (68.5%) had full staging information. Only 5.4% (n = 837) of cancers were diagnosed at an early stage (T0/1, N0 and M0). The proportion of cancers diagnosed early was significantly associated with a history of Barrett’s oesophagus (9.6% vs 2.0%, P < 0.001), but not with patient’s age, sex, and performance status. Adenocarcinomas were significantly more likely to be diagnosed early compared to squamous cell cancers (5.7% (95% CI 5.3–6.2%) vs 3.8% (95% CI 3.1–4.6%)). After adjusting for age, sex, number of comorbidities and type of cancer, we observed significant variation in the proportion of cancers diagnosed at an early stage across SCNs [(3.1% (95% CI 2.3–4.0%) - 8.6% (95% CI 6.7–10.7%))]. Conclusion: There is substantial nationwide variability in the proportion of cancers diagnosed at an early stage. This needs to be monitored at a Trust level, and investigated where rates are low. Causative factors may reflect the social demographic
ª 2015 The Authors. European Journal of Cancer Care ª 2015 John Wiley & Sons Ltd Vol 24 (Suppl. 1); June 2015; 1–23
Cancer Screening, Early Diagnosis of Cancer
of the local population and recognition of symptoms by the patient, access to GP services for referral for endoscopy, and availability of endoscopy services at the local hospitals. The ‘Be clear on cancer campaign’ aims to address the first of these factors, but SCNs need to take responsibility for the later two.
Abstract O-06 Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers Gary Abel1, Jon Shelton2,3, Sam Johnson3, Lucy Elliss-Brookes3, Yoryos Lyratzopoulos1,3,4 1 Cambridge Centre for Health Services Research, 2 Care Quality Commission Care, 3 National Cancer Intelligence Network, 4 Health Behaviour Research Centre, University College London Although socio-demographic and cancer site variation in risk of cancer diagnosis via emergency presentation has been previously described, relatively little is known about how this risk may vary by sex, age and deprivation group between patients with a given cancer. Data were analysed from the Routes to Diagnosis project on 749,645 patients (2006–10) with any of 27 cancers. Crude proportions and crude and adjusted odds ratios were calculated for Emergency Presentations and interactions between sex, age and deprivation with cancer were examined. The overall proportion of patients diagnosed through Emergency Presentation varied greatly by cancer. Compared with men, women were at greater risk of emergency presentation for bladder, laryngeal, and lung cancer (e.g. bladder cancer specific sex odds ratio 1.50, 95% CI 1.42–1.58), whereas the opposite was true for oral/oro-pharyngeal cancer, lymphomas and melanoma (e.g. oro-pharyngeal cancer specific sex odds ratio 0.49, 95% CI 0.36–0.66). Similarly, younger patients where at higher risk of emergency presentation for acute leukaemias, colon, stomach and oesophageal cancer (e.g. colon cancer specific 35–44 vs. 65–74 year olds odds ratio 2.01, 95% CI 1.81–2.23); and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin’s Lymphoma (e.g. laryngeal cancer specific 35–44 vs. 65–74 year olds odds ratio 0.19, 95% CI 0.05–0.76). Inequalities in risk of emergency presentation by deprivation group were greatest for oral/oro-pharyngeal, anal, laryngeal and small intestine cancers. Among patients with the same cancer, risks of emergency presentation vary notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated with psychosocial processes which can delay seeking of medical help and difficulties in suspecting the diagnosis of cancer after presentation.
Abstract O-07 Increasing uptake in the bowel cancer screening programme with GP participation: the PEARL Project Sally Benton1, Piers Butler1, Katy Reed1, Sally Rickard2, Sally Stanley2, Michelle Chesters2, Richard Roope2, Stephen Halloran1 1 NHS Bowel Cancer Screening Programme - Southern Hub, 2 Wessex Strategic Clinical Network There is wide variation in uptake of bowel cancer screening in England. Areas with a high index of multiple deprivation
(IMD) score (more deprived) have lower uptake than areas with low IMD (less deprived). Initiatives to raise awareness of bowel cancer and screening have been sporadic and have not been sustained. Previous studies have demonstrated endorsement by a general practitioner (GP) can increase uptake of bowel cancer screening. The Bowel Cancer Screening Programme (BCSP) Southern Hub is piloting a sustainable intervention to engage subjects in bowel cancer screening, exploiting GP patient knowledge and the Hub’s established procedures for communication. Participating practices supplied the Hub with a letterhead and GP signature. A computer program was developed to interrogate the BCSP database and identify non-participants (>30 days after standard reminder letter) in these practices The non-participating subject list was emailed to each practice for GPs to identify those not suitable for GP reminder (end-of-life-care, unable to have colonoscopy, etc). The list was returned to the Hub to exclude recent responders. Subjects on the final list received an approved GPendorsed reminder letter on GP-headed and signed stationery. Practices returning three lists received a financial reward. 46 practices with uptake
