Cancer Awareness, Screening and Diagnostic Pathways Research Group

Cancer outcomes, including survival rates, have improved significantly over the years, but in order to ensure every person with cancer has the very best diagnosis, treatment and care, more research is needed.

The Cancer Awareness, Screening and Diagnostic Pathways Research Group (CASP) exists within Hull York Medical School and the Institute for Clinical & Applied Health Research at the University of Hull to support colleagues engaged in applied health cancer projects, with a particular focus on tackling health inequalities.


A sociological examination of socio-economic inequalities in breast screening experiences

Student: Emily Lunn

PhD project: Exploring perceptions and experiences of NHS breast screening for socio-economically disadvantaged women in Yorkshire.

Funder: Yorkshire Cancer Research

Start date: October 2020

Supervisors: Dr Jo Cairns and Professor Una Macleod 


The overall purpose of this research is to obtain an in-depth understanding of the lived experiences of women who live in socio-economically disadvantaged areas of Yorkshire and who experience multiple inequalities to gain an understanding of their experiences and perceptions of the NHS breast screening programme.


The NHS breast screening programme in the UK invites women aged 50-70 and without symptoms for breast screening every 3 years. Breast screening detects cancer in the earlier stages and improves the chances of survival. However, existing data shows that women who live in more disadvantaged communities have lower uptake of breast screening and access to breast screening is impacted by structural and systemic barriers as well as cultural differences, personal beliefs, and attitudes.

Despite decades of interventional research to improve the uptake of breast screening, we still see inequalities in breast screening. Therefore, this study looked to understand the nuances of everyday life for women living in socio-economically disadvantaged areas in order to understand what barriers they experience and how these can be overcome.

The research adopted a qualitative research design, comprising interviews and focus groups with 35 women, which is most suitable for providing biographical and contextual understanding. By incorporating the views of women into research, we can better comprehend how structural inequalities and fears of discrimination, marginalisation, and indignity impact breast screening uptake.

However, inequalities do not happen in isolation. People living in disadvantaged areas are also more likely to experience multiple inequalities. Therefore, a Qualitative Evidence Synthesis and meta-ethnography have been undertaken to explore the intersections of these inequalities with socio-economic disadvantage to strengthen our understanding of the impact on breast screening attendance.

Catch Up Screen

Title: Catch Up Screen

FunderYorkshire Cancer Research

ContactProfessor Una Macleod and Dr Alex Young

Catch-up Screen is a research project offering cervical screening to women in their 60s and 70s from a urine sample they can take themselves at home. The urine kit will be sent to selected women by post, with pre-paid return packaging included so that the urine sample can be posted directly to the laboratory for testing afterwards.

This additional “Catch-up Screen” is not normally offered by the NHS, so it provides an opportunity for an additional cervical screen without the need to visit a GP practice for a smear test. The project results will help the NHS to decide whether a catch-up urine test should be offered to all women in their 60s and 70s.

The Catch-up Screen project is being run in selected GP practices across Manchester and the Yorkshire and Humber regions. Eligible patients in these regions will be contacted by their GP practice and invited to take part. You cannot volunteer for this study.

Patients from participating GP practices may be invited to take part if they are aged between 60 and 79 and are no longer being invited for routine cervical screening as part of the NHS programme. Women cannot take part if they have had a hysterectomy which included the removal of their cervix.

The research project is sponsored by the London School of Hygiene & Tropical Medicine (LSHTM). Assistant Professor Clare Gilham and Professor Julian Peto from the LSHTM are leading this research in collaboration with Professor Emma Crosbie from the University of Manchester, and Dr Belinda Nedjai at Queen Mary University of London.

Find out more about the project.


Title: Cancer Diagnosis via Emergency Presentation: a case-control study (EMPRESS)

Funding: Cancer Research UK

Contact: Professor Una Macleod

Cancer remains one of the UK’s biggest health issues, both in terms of morbidity and mortality. In recent years there has been increasing interest in the pathway to diagnosis, as international data have shown that one year survival figures for many cancers are poorer in the UK than in comparable countries. It is already well established that for the majority of cancers, diagnosis within the context of an emergency presentation results in poorer outcomes. The purpose of this study is to investigate what happens to patients in the period before presentation as an emergency on the ‘route to diagnosis’.

The overall aim of this study is to identify whether there are differences in pathway to diagnosis between patients who are diagnosed with lung or colorectal cancer during an emergency presentation compared to those diagnosed via the 2ww pathway. The data collection for this study has been completed and it is being written up for publication.

Evaluating the Impact of Delivery Methods on Socioeconomic Inequalities in Lung Cancer Screening Uptake and Health Inequality

Student: Arwa Abdel Aal

PhD project: Evaluating the Impact of Delivery Methods on Socioeconomic Inequalities in Lung Cancer Screening Uptake and Health Inequality

FunderYorkshire Cancer Research

Supervisor: Professor Una Macleod

This PhD project aims to evaluate health inequalities in lung cancer screening across five different delivery models. Its primary aim is to gauge the inequalities in uptakes of lung cancer screening programmes by diverse socioeconomic groups and the consequent impact of such inequalities on overall health disparities. The research will conduct subgroup analyses using data from five distinct lung screening trials: the UK Lung Screening Trial (UKLS) and programmes in Liverpool, Manchester, Tameside, and Hull, considering variables such as age, the Indices of Multiple Deprivation (IMD), and gender.

The project's goals include evaluating the effect of a national rollout of these models through distributional cost-effectiveness analysis (DCEA). The overarching ambition is to analyse the effects of varying Lung Health Check (LHC) programme delivery models on population health inequalities.

Exploring access to specialist cancer centres for patients in coastal areas, an assessment of the psychosocial, socioeconomic, psychological and health implications

Student: Rebecca Price

PhD project: Exploring access to specialist cancer centres for patients in coastal areas, an assessment of the psychosocial, socioeconomic, psychological and health implications

FunderYorkshire Cancer Research

Start date: October 2020

SupervisorsDr Charlotte Kelly (primary) and Professor Una Macleod (secondary)


To explore access to specialist cancer centres for patients in coastal areas, through an assessment of the psychosocial, socioeconomic, psychological and health outcomes.


Since the development of specialist cancer centres, the need to travel has become an increasing burden for some patients.

Using both qualitative and quantitative methods, this research will explore the travel experiences of patients undergoing cancer treatments, particularly in coastal communities, along with the psychosocial, socioeconomic and health implications.

Exploring GP referral behavior for serious non-specific symptoms (SNSS) where cancer is suspected

Title: Exploring GP referral behavior for serious non-specific symptoms (SNSS) where cancer is suspected.

ContactDr Charlotte Kelly

FunderYork and Scarborough Teaching Hospitals NHS Trust

Patients who attend a GP with serious but nonspecific symptoms (SNSS) where cancer is suspected do not currently meet the criteria for site specific urgent referral for cancer.

The consequences of this are that they are more likely to have multiple healthcare visits and longer times to diagnosis than patients presenting with site specific symptoms.

This study will explore the GP referral behavior and the use of a Rapid Diagnostic Centre Service referral pathway for these patients through a series of interviews with GPs.


Title: Improving help-seeking for and primary care management of lung symptoms in Hull

Funding: Yorkshire Cancer Research

Contact: Julie Walabyeki

Incidence and deaths from lung conditions are more common in Hull than in England as a whole, and higher than any other area of Yorkshire. Hull is the 3rd most deprived local authority in England and has the highest prevalence of smoking in England. Previous research conducted in Hull and surrounding areas suggests that not only do smokers experience cough and breathlessness than non-smokers, they are also less likely than non-smokers to consult their doctor for cough. There is therefore a need to develop interventions, which would result in patients at risk of lung conditions, seeking help earlier and being referred sooner for lung symptoms.

Our aim is to improve earlier diagnosis of lung conditions by working to support 1) People to see their doctor if they get lung symptoms, and 2) GPs to refer people sooner.

Socio-economic inequalities in the diagnosis and treatment of bowel and ovarian cancer

StudentDr Benjamin Pickwell-Smith

PhD project: Socio-economic inequalities in the diagnosis and treatment of bowel and ovarian cancer

FunderYorkshire Cancer Research

Time frame: November 2021 to November 2026

SupervisorProfessor Una Macleod

Bowel cancer is the fourth most common cancer in the United Kingdom (UK) with around 110 new cases diagnosed every day. Ovarian cancer is the sixth most common cancer affecting women in the UK, with around 20 new cases diagnosed every day.

Research has shown that cancer survival (the percentage of people still alive after a particular amount of time following a diagnosis of cancer) is lower for patients living in less affluent areas of England. The reasons for this are not fully understood. This research study aims to look for inequalities (differences) and their causes in cancer care. This might help explain what we can do to reduce these inequalities.

We will explore whether patients diagnosed with bowel or ovarian cancer living in less affluent areas:

  • Experience more delays in reaching a diagnosis, compared with other patients
  • Receive different treatments, compared with other patients

This project will use cancer registration data which is routinely collected by the National Cancer Registration and Analysis Service (the cancer registry in England, part of Public Health England). We will seek to access cancer registration data about all patients living in England who were diagnosed with bowel or ovarian cancer between 2016- 2017. This data will include details about each patient’s: 

  • Characteristics (such as their age at diagnosis, presence of other medical conditions, or their ethnicity)
  • Their cancer (such as how advanced it is)
  • Information about their treatment and how they came to be diagnosed.

We will look at the extent to which any differences in diagnostic or treatment times, or in the treatments received, can be explained by patient demographics such as age, number of medical conditions and the affluence of their area of residence. 

We will only have access to de-personalised data. It will be kept in a secure environment with strict controls over who is able to access it. After the study, all records will be securely destroyed.

Download the Privacy Notice for the project (PDF)

TRANSFORMing Cancer Outcomes in Yorkshire

Title: TRANSFORMing Cancer Outcomes in Yorkshire – funded by Yorkshire Cancer Research

Funding: Yorkshire Cancer Research

Contact: Professor Una Macleod

The Academy hosts key projects within the Transform programme. Cancer outcomes are poorer in Yorkshire than in England as a whole and especially poor in Hull. People with higher socioeconomic status have substantially better health than those with lower socioeconomic status; this is also true of cancer outcomes.

TRANSFORMing Cancer Outcomes in Yorkshire – funded by Yorkshire Cancer Research, or ‘TRANSFORM’, is a programme of research that aims to tackle these inequalities.

TRANSFORM is funded by an award of £4.9million from Yorkshire Cancer Research and will primarily focus on early diagnosis and detection of cancer, patient management and survivorship and palliative care.

For more information please visit the TRANSFORM pages.

WORKPLACE: Improving lung health at the WORKPLACE

Title: WORKPLACE: Improving lung health at the WORKPLACE

Funding: Yorkshire Cancer Research

Contact: Julie Walabyeki

More people are diagnosed with and die from lung cancer in Hull than any other place in Yorkshire. This is because Hull has the highest number of people who smoke in England. It is known that if lung cancer is diagnosed earlier, people are more likely to live for longer. This is also true for patients with lung cancer who stop smoking before treatment.

National statistics suggest that people within manual/routine occupations are likely to smoke more than those in other jobs and are therefore an important group to target. These workers include postal workers, receptionists, food, drink and tobacco process operatives, assemblers and construction workers for example. This study will further develop our work in improving lung health in Hull by extending a previous study into workplaces with mostly manual/routine employees. We gained experience in developing a media and community-based intervention to promote lung health and demonstrated an increased awareness of potential lung cancer symptoms. We will build on this by adapting the intervention for use in workplaces. We also seek to enhance our intervention that will increase awareness of potentially serious chest symptoms with initiatives that help people to stop smoking.

We would like to find out whether the workplace is a suitable environment to engage with employees regarding lung health, recognition of potentially serious chest symptoms and going to see the doctor and whether there is a suitable intervention that can be used at the workplace. 


1. To find out whether using the workplace is a suitable environment to work with employees to:

a. Learn more about lung health.
b. Recognize potentially serious chest symptoms.
c. Encourage the employees to contact the doctor as soon as possible. 


Completed Projects

Cervical screening study

Title: Cervical screening study

ContactAlison Bravington

The incidence of cervical cancer in women over fifty in the UK is predicted to rise by 62 per cent over the next twenty years – by 2036, the highest incidence of cervical cancer will be seen in women aged 50 to 59.

A quarter of all women do not attend for cervical screening – the reasons for non-attendance specific to women over 50 remain largely unexplored. It is imperative to gain a better understanding of the cervical screening experience from the perspective of women in this age group, with a view to addressing problems and increasing attendance

This project aims to explore experiences of screening among women over 50 and the health care practitioners who screen them, and to develop interventions to increase attendance, and to promote screening practice which is sensitive to the needs of women in this age group.

GP waiting room

Title: GP waiting room

Contact: Alison Bravington

It has been shown that passive interventions such as leaflets and posters are an effective way of promoting healthy behaviours, but research in this area tends to focus on a broad range of health information.

This study will focus specifically on information that promotes awareness of cancer symptoms, and how this is distributed and taken up by patients in GP waiting rooms.

The policy question addressed by the study is: how do and how can general practice waiting rooms best raise awareness of the signs and symptoms of different cancers?



CASP research group members
Name Role
Dr Olufikayo Bamidele Research Associate (Evidence Synthesis)
Dr Joanne Cairns Research Fellow
Sarah Greenley Research Fellow (Information Specialist)
Dr Charlotte Kelly Lecturer in Applied Health Research (Health Inequalities)
Dr Micky Kerr Research Fellow (PRIORITY Study)
Professor Una Macleod Professor of Primary Care Medicine
Dr Hannah Miles Research Associate
Jackie Newman Research Study Administrator (PEOPLE-Hull Study)
Cecilia Pompili Clinical Senior Lecturer in Psychosocial Oncology
Dr Julie Walabyeki Lecturer in Primary Care
Dr Alex Young Research Associate


PhD students

  • Arwa Abdel-Aal
  • Lauren Beadle
  • Emily Lunn
  • Ben Pickwell-Smith
  • Rebecca Price