Do the UK public realise that colorectal cancer is a common cancer?

Dear Sir, Colorectal cancer (CRC) is one of the top three most commonly diagnosed cancers among women and men. However, it is widely acknowledged that it receives less attention than other cancers. Breast cancer gets the most public attention because of its high incidence and iconic status [1]. Lung cancer attracts attention because of its established link with smoking [2], and prostate cancer is sometimes presented as the neglected ‘male equivalent’ of breast cancer [3]. Recognition of the high incidence of CRC is particularly important in the UK because the new national screening programme based on biennial Faecal Occult Blood (FOB) Testing has recently been introduced. In the first 28 months of the screening programme, uptake in England was only around 55% (von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, Obichere A, Handley G, Logan R, Rainbow S, Smith S, Halloran S, Wardle J, submitted). This contrasts with uptake of around 74% in breast screening [4] and 80% in cervical screening [5]. Lack of awareness of CRC’s high prevalence may contribute to low uptake of CRC screening [6,7]. One study has demonstrated that informing people that CRC is common and often asymptomatic can lead to increased awareness of risk and a decision to be screened in up to 50% of those who had initially declined the test [8]. Awareness that CRC is a common cancer has been found to be low in several studies using a recognition-based methodology [9–11], and may be even lower if measured using open recall questions [12]. We report findings from research using a populationbased UK sample investigating awareness of the high incidence of CRC using an open response format. Data were collected as part of the Office for National Statistics (ONS) Opinions Survey in September and October 2008. This uses stratified random probability sampling and a computer-assisted, face-to-face interview. Respondents were asked about common male and female cancers using the following questions: ‘What do you think is the most [then second then third most] common cancer in women [men]’. Both men and women were asked the questions for both sexes. Responses were recorded verbatim. Of 3652 households invited to participate, interviews were completed with one person from each of 2216 households (61% response rate), of whom 2208 (968 males and 1240 females) completed the questions on common cancers (99.6%). Awareness that CRC is a common female cancer was extremely low (16%), with men less likely to identify it as a common female cancer (12%) than women (20%). Older respondents were more likely to name CRC as a common female cancer than younger respondents (22% at ‡ 65 years vs 9% at 16–24). There were no other demographic differences. Awareness that CRC is a common male cancer was higher (40%). Again, women had higher awareness than men (43% vs 36%) and the youngest respondents were the least likely to name CRC as one of the top three (19% at age 16–24). Awareness was higher in respondents who were married and from higher socioeconomic and white ethnic backgrounds. The most frequently reported female cancers (in any order) were: breast cancer (94%), cervical cancer (60%) and lung cancer (34%) (Fig. 1). The fourth and fifth most frequently mentioned cancers were ovarian cancer (19%) and skin cancer (18%). CRC, named by 16% of respondents, was sixth in the list. The most frequently reported male cancer was lung (70%), followed by prostate (65%) and CRC (40%). However, 29% of respondents identified testicular cancer as being in the top three, and 13% identified skin cancer (see Fig. 2). As far as we are aware, this is the first population-based study assessing awareness of CRC in relation to other common cancers in which respondents were simply asked to name common cancers. The results show that the British are largely unaware of the high incidence of CRC, and significantly less aware than they are of the other ‘top three’ cancers. Over 80% of respondents failed to identify CRC as being among the top three female cancers and 60% failed to identify it as a common male cancer. Although awareness was somewhat higher in older age groups, who are the target for CRC screening, it was still relatively low, despite information being available in the leaflet that accompanies the screening invitation. Lack of public awareness of CRC might be partly due to media under-reporting relative to the disease burden. The media prefers to focus on positive cancer stories, and with relatively high mortality, CRC performs poorly. CRC may also be associated with embarrassment because of difficulties with discussing a private body area and its functioning [13], which could contribute to low levels of media coverage. However, the new UK government’s commitment to CRC screening, including the introduction of flexible sigmoidoscopy screening (based on evidence from