Dr Elizabeth Towers, NHS Essex System Clinical Lead for Cancer
When we talk about earlier cancer diagnosis, we tend to focus on screening, tests, referrals and appointments.
All are essential. But whether someone reaches those points, and how quickly, is shaped by decisions made much earlier. It may start with a letter they are unsure whether to open, a change in their body they keep noticing, a search online late at night or a conversation with someone they trust.
Many of these decisions happen before someone contacts the NHS. As a GP, I know that sometimes people can be unsure whether a change is serious enough to raise with their GP practice or worry that they are asking for help unnecessarily. That uncertainty can mean they wait longer before seeking advice.
To diagnose cancer earlier and reduce inequalities, we need to understand what makes people hesitate and what would make it easier to seek advice sooner. That means listening to people’s experiences and using what we learn to change how we support them.
Trusted conversations in familiar settings
Our recent breast screening microgrants give an example of what that can look like.
Eight local organisations were given small grants to talk about breast screening with the communities they already knew and supported. Instead of expecting people to come to an NHS setting, conversations took place in community hubs, faith groups, social settings and other familiar spaces.
The organisations decided how best to approach the subject. They used peer support, lived experience, Urdu translation, tactile materials for blind and partially sighted women and opportunities to ask health professionals questions in a relaxed setting.
At Age Concern Southend, a woman in her 70s learned that she could still request breast screening. She later returned to the hub for the contact details she needed to arrange it.
At another session, a woman who had never attended screening listened as a trusted member of her community explained the process in Urdu. She began asking questions about privacy and support and requested a follow-up conversation with a view to booking an appointment.
For blind and partially sighted women, the discussion was not simply about whether screening was important. It revealed how inaccessible information, difficulties navigating healthcare settings and not knowing what support was available could affect someone’s confidence. After the session, seven of the eight women who provided feedback said they felt more confident about attending screening.
These are individual examples, but they show the difference that the right conversation, in the right setting, can make.
The value of the grants went beyond the sessions themselves. They helped us hear concerns that we might not otherwise hear, while trusted local organisations could respond immediately with practical information and reassurance. Eight organisations now have Breast Screening Champions who can continue those conversations within their communities.
The breast screening work also used a survey to understand people’s experiences. Some of the concerns raised informed a film about what happens at a screening appointment, which has now been viewed more than 15,000 times.
Applying what we learn
What I find particularly encouraging is that we can build on this approach.
Our cervical screening work has also combined a public survey with community activity. People told us about anxiety, embarrassment, previous negative experiences and practical difficulties attending. That insight has influenced a new series of short films in which a local GP answers the questions people actually ask: what happens at an appointment, what support and adjustments are available, and how to return to screening after missing previous invitations.
We are taking the same approach to cancer symptoms and help-seeking.
When we asked 1,500 Essex residents how they might respond to symptoms associated with ovarian cancer, around seven in ten said they would be concerned. Yet only around four in ten said they would make a GP appointment.
The important finding was not simply that more symptom awareness was needed. People could recognise that something might be wrong and still hesitate because they were unsure whether it was serious enough, worried about wasting their GP’s time or concerned about getting an appointment.
That insight has shaped an ovarian cancer campaign which will address those concerns alongside awareness of the symptoms themselves. In the new year, microgrants will support local organisations to bring the campaign into trusted community settings and help women feel more confident about seeking help.
We also plan to use microgrants to support bowel screening activity. Before that begins, our current bowel cancer survey is asking people across Essex about screening, possible symptoms and what might influence whether they seek help. The findings will help us identify barriers and decide where information and support could make the greatest difference in 2027.
Listening in different ways
Not every question can be answered through a large survey or a community event. Our forthcoming prostate cancer engagement will use stakeholder interviews, group discussions and one-to-one conversations with two groups: Black men aged 45 and over, and men with a parent or sibling who has had prostate, breast, ovarian or pancreatic cancer. This will allow us to explore awareness of risk, experiences of healthcare, what influences men’s decisions about seeking advice and what information or other support would be most useful.
Listening should not stop at diagnosis. Through the Improving Cancer Journeys programme in Southend, people affected by cancer and local partners are helping to shape the practical, physical and psychological support available during and after cancer care. They are also showing us what matters beyond clinical treatment and how services can respond to people’s wider needs.
These projects use different methods because they ask different questions, but together they show us what encourages people to take part in screening, seek help or access support, and what may get in the way.
Improving cancer outcomes through earlier diagnosis is a priority in the Essex Population Health Improvement Plan for 2026/27. Effective screening, tests and clinical pathways are vital, but people must be able to reach them to benefit.
Listening helps us understand what happens before that point and design information and community activity around the decisions people actually face.
Take part in our bowel cancer survey
Our bowel cancer survey is open until Monday 7 December. If you live in Essex, please take part. What you tell us will help shape practical support for people to complete bowel screening and seek help about possible symptoms.
Take the bowel cancer survey