The ‘Small c’ campaign

LTP Priority: Cancer

Population Intervention Triangle :Segments (link to Section 1 PHE PBA): Service

Type of Intervention: The ‘Small c’ campaign

Major driver of health inequalities in your area of work

Unwarranted variation in early diagnosis of breast and lung cancer

Target groups

Deprivation and Protected Group – Black and minority ethnic communities


Increasing public awareness and early diagnosis of breast and lung cancer in East London


Survival rates from cancer in England are lower than in comparative countries and are likely to be linked to late diagnosis. Low public awareness of cancer is an important factor in late diagnosis. In East London, survival rates from cancer are particularly low with evidence of low public awareness and perceived barriers to presenting early to a doctor with cancer symptoms. · The ‘small c campaign’ in 2011/2012 used a social marketing approach to increase public awareness of breast and lung cancer in local populations. It was a collaboration between the East London PCTs in City and Hackney, Newham, Tower Hamlets and Waltham Forest, funded by the Department of Health as part of the Cancer National Awareness and Early Diagnosis Initiative.


  • The campaign was effective in engaging communities at highest risk. Around 10,000 people at increased risk of late diagnosis of lung and breast cancer were engaged in cancer awareness by community organisations and pharmacies between June 2011 and March 2012.
  • While improvements in cancer awareness were not evident at wider population level, there were increases in awareness at local level measured by community organisations engaged with target groups through peer education. Regular breast checking increased from 37% to 46% in 192 female relatives engaged through a school-based programme in Newham. In a 20% follow-up sample of women engaged in Tower Hamlets, 73% (34) reported checking their breasts regularly compared with 38% in the general population.
  • There were increases in GP referrals for suspected breast cancer and lung cancer in all four boroughs coinciding with the campaign.

Breast cancer referrals increased by 22% from a monthly average of 261 in 2010/11 to 319 in 2011/12. Lung cancer referrals increased by 64% from a monthly average of 33 in 2010/11 to 54 in 2011/12.

  • There was an increase in the number and proportion of lung cancers diagnosed at an earlier stage reported by Hospital Trusts which serve the four boroughs 17% (70 of 403 lung cancers) were diagnosed at stage I or II in 2010 18% (78 of 429 lung cancers) were diagnosed at stage I or II in 2011 21% (83 of 398 cancers) were diagnosed at stage I or II in 2012
  • In Tower Hamlets, where survival rates from breast cancer had been the lowest in England, Barts Health reported a reduction in the proportion of late stage breast cancers. 13% (9 of 70 breast cancers) diagnosed in 2010/11 had metastatic disease compared to 9% (7 of 77 breast cancers) diagnosed in 2011/12 with metastatic disease

Below is a paper outlining the project: