In this guest blog, Laragh Harvey-Kelly, a final-year medical student at the University of Cambridge, explains her recently published work on public attitudes to kidney cancer screening. She undertook this research as part of a Student Selected Component supervised by Dr Juliet Usher-Smith.
Kidney cancer is on the rise and is projected to increase over the next 15 years. It is a ‘silent’ disease – meaning that by the time symptoms present, it has often spread throughout the body. This would make kidney cancer an ideal candidate for a screening programme which may be able to improve survival by catching it early before metastasis. Juliet Usher-Smith, Sabrina Rossi and Grant Stewart have been exploring the current evidence on screening for kidney cancer and highlighted that for a screening programme to work, you need the public to attend when they are invited. Our aim was to find out the public’s attitudes towards a potential screening programme for kidney cancer, as well as factors which may make them more or less likely to attend.
Our team conducted an online survey which had over 1000 responses from people aged 45-77 years. The participants were asked about personal and lifestyle factors, and then were shown information about kidney cancer and the potential benefits and drawbacks of screening. Furthermore, they were given information about five different screening types; a urine test, a blood test, an ultrasound scan, a low-dose CT scan of kidneys and finally a low-dose CT scan including both the lungs for lung cancer screening and the kidneys.
General enthusiasm towards screening, despite low awareness of kidney cancer
Our most important finding was that the public were generally enthusiastic about screening for kidney cancer – over 98% of participants would attend screening by at least one method, and 73% would attend screening by all five of the methods. Interestingly, this was despite over 80% knowing nothing about kidney cancer or having only heard of the condition before participating in the survey.
Screening method matters, and so do other factors
Adjusted analysis showed that compared with intention to take up screening with a urine test, participants were just as likely to undergo screening by combined lung and kidney CT, half as likely to report that they intended to undergo blood or ultrasound testing, and half again as likely to report that they intended to take part in a screening programme featuring a low dose CT scan of the kidneys only. Factors leading to higher likelihood of attending screening included higher BMI and higher general cancer worry. We found that in those who had a lower general cancer worry, the decision to take up screening was more affected by worry about the specific screening test.
On the whole we found the public to be receptive to a kidney cancer screening programme, with high potential uptake rates, and we have highlighted the influence of screening modality on uptake. Further research by the team is in progress, in which we have analysed the free text responses by the participants to explore in depth why different screening modalities are preferable to certain people, as well as exploring the public’s attitudes towards risk stratified screening; screening in which only a select proportion of the population is invited based on various risk factors.
I would like to thank Juliet Usher-Smith from the Primary Care Unit who has been instrumental in leading this research and facilitating this work as part of my clinical studies. It has been a pleasure working with her and the rest of the team!
This blog was first published by the Cancer Research UK Cambridge Centre’s Urological Malignancies Programme
Laragh L. W. Harvey‑Kelly, Hannah Harrison, Sabrina H. Rossi, Simon J. Griffin, Grant D. Stewart and Juliet A. Usher‑Smith, Public attitudes towards screening for kidney cancer: an online survey in BMC Urology (2020) 20:170 https://doi.org/10.1186/s12894‑020‑00724‑0
Lucy Lloyd, Communications, Primary Care Unit