WP4: Screening, Prevention & Early Diagnosis in Primary Care

Prevention, Screening and Early Diagnosis focuses on significant public health problems and inequalities in Wales, continuing strong work in cancer and addressing other priority health areas.

Our aims are to: (i) develop strategies to prevent obesity-related disease and reduce harm from tobacco, (ii) increase public awareness and improve equitable uptake of screening programmes, and (iii) expedite early diagnosis.

We involve patients and members of the public in developing, evaluating and implementing novel, person-centred interventions designed to improve Screening, Prevention and Early Diagnosis.

Core activities

  • Build research capacity by developing and delivering high quality, multidisciplinary Screening, Prevention and Early Diagnosis research funding proposals.
  • Cultivate strong academic-community partnerships by involving local stakeholders in co-production of research proposals, conduct and dissemination activities.
  • Conduct research that is underpinned by behavioural science, sociological theory and a ‘whole person’ approach to ensuring that ground breaking biomedical research is translated into public and patient benefit.


Dr Kate Brain, Cardiff University

Current projects

  1. ABACus study - Development and pilot evaluation of the Tenovus health check
  2. Androgens - Choice of Intermittent vs Continual - Prostate Cancer
  3. CLASP - Cancer Life Affirming Survivorship Support in Primary Care
  4. How can we help health care professionals to support patients with long term neurological conditions in the self-management of their conditions?


Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study. Eur J Cancer Prev, Volume 24, 3 May 2015 pp.253-260 

Rubin G, Berendsen A, Crawford M, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C The expanding role of primary care in cancer control. Lancet Oncology Commission; 16(12):1231-72

Hamilton W, Walter FM, Rubin GR, Neal RD. Improving early diagnosis of symptomatic cancer.     Nature Reviews Clinical Oncology (2016) doi:10.1038/nrclinonc.2016.109 Published online 26 July 2016
Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial. Brain K, Lifford KJ, Carter B, Burke O, McRonald F, Devaraj A, Hansell DM, Baldwin D, Duffy SW, Field JK. Thorax. 2016 Nov;71(11):996-1005. doi: 10.1136/thoraxjnl-2016-208283. Epub 2016 Jul 28.

Identifying people at higher risk of melanoma across the UK: a primary care based survey. Usher-Smith JA, Kassianos AP, Emery JD, Abel GA, Teoh Z, Hall S, Neal RD, Murchie P, Walter FM. Br J Dermatol. 2016 Dec 23. doi: 10.1111/bjd.15181. [Epub ahead of print]

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database. Vaccine, Volume 33, 32 July 2015 pp.3873-3880 Rees P, Edwards A, Powell C, Prosser Evans H, Carter B, Hibbert P, Makeham M, Sheikh A, Donaldson L, Carson Stevens A 
Hamilton W, Stapley S, Campbell C, Lyratzopolous G, Rubin G, Neal RD. For which cancers might patients benefit most from expedited symptomatic diagnosis? Construction of a ranking order by a modified Delphi technique. BMC Cancer 2015, 15:820.

McCutchan G, Wood F, Edwards A, Richards R, Brain, K. Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review. BMC Cancer (2015) 15:1000. DOI 10.1186/s12885-015-1972-8

Din NU, Ukoumunne OC, Rubin G, Hamilton W, Carter B, Stapley S, Neal RD. Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers: Analysis of Data from the UK Clinical Practice Research Datalink. PLoS ONE 2015 10(5): e0127717. doi:10.1371/journal.pone.0127717

Women’s perspectives on primary Human Papillomavirus self-sampling in the context of the UK cervical screening programme. Williams D, Davies M, Farewell D, Hillier S, Brain K. Health Expect. 2017 Feb 10. doi: 10.1111/hex.12544. [Epub ahead of print]

Hubbard G, Macmillan I, Forbat L, Neal RD, O'carroll RE, Haw S, Rauchaus P, Kyle RG, School-based brief psychoeducational intervention to raise adolescent cancer awareness and address barriers to medical help-seeking about cancer: a cluster randomised controlled trial. Psycho Oncology. 2015 10.1002/pon.4001.

The cancer care experiences in gay, lesbian and bisexual patients:  A secondary analysis of data from the UK Patient Experience Survey. Hulbert-Williams NJ, Plumpton CO, Flowers P, McHugh R, Neal RD, Semlyen J, Storey L.  Eur J Cancer Care (Engl). 2017 Feb 27. doi: 10.1111/ecc.12670. [Epub ahead of print]

The diagnostic value of symptoms of possible oesophagogastric cancer in primary care populations: systematic review and meta-analysis. Astin MP, Martins T, Welton N, Neal RD, Rose PW, Hamilton W. Br J Gen Pract. 2015 Oct;65(639):e677-91. doi: 10.3399/bjgp15X686941.

Shephard E, Neal RD, Rose P, Walter F, Hamilton W. Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients: a case-control study using electronic records. British Journal of General Practice 2015;e289-293. 

International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data. Brian D Nicholson, David Mant, Richard D Neal, Nigel Hart, Willie Hamilton, Bethany Shinkins, Greg Rubin, Peter W Rose. Br J Gen Pract. 2016 Feb;66(643):e106-13. doi: 10.3399/bjgp16X683449. 

Symptoms of adult chronic and acute leukaemia before diagnosis: Large primary care case-control studies using electronic records. Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W. British Journal of General Practice 66(644):e182-e188. March 2016

An investigation of routes to cancer diagnosis in 10 international jurisdictions, as part of the International Cancer Benchmarking Partnership: Survey development and implementation. Weller D, Vedsted P, Anandan C, Zalounina A, Fourkala EO, Desai R, Liston W, Jensen H, Barisic A, Gavin A, Grunfeld E, Lambe M, Law R, Malmberg M, Neal RD, Kalsi J, Turner D, White V, Bomb M, Menon U. BMJ Open 6(7):e009641 · July 2016. DOI: 10.1136/bmjopen-2015-009641

Rose PW, Rubin G, Perrera-Salazar R, Almberg SS, Barisic A, Dawes M,  Grunfeld E, Hart N, Neal RD, Pirotta M, Sisler J,  Toftegaard BS, Thulesius H, Vedsted P, Young J, Hamilton W. Explaining variation in cancer survival between eleven jurisdictions in the International Cancer Benchmarking Partnership: a primary care survey. BMJ Open 2015;5:e007212 doi:10.1136/bmjopen-2014-007212

Ali, N., Lifford, K., Carter, B., McRonald, F., Yadegarfar, G., Baldwin, D.R., Weller, D., Hansell, D.M., Duffy, S.W., Field, J.K., Brain, K. Barriers to uptake among high-risk individuals declining participation in lung cancer screening: A mixed-methods analysis of the United Kingdom Lung Cancer Screening (UKLS) trial. BMJ Open 2015;5:e008254. doi:10.1136/bmjopen-2015-008254

Davies F, Edwards A, Brain K, Edwards M, Jones R, Wallbank R, Robertson N, Wood F. “You are just left to get on with it”: qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis. BMJ Open 2015;5:e007674. doi:10.1136/bmjopen-2015-007674.

Field JK, Duffy SW, Baldwin DR, Whynes DK, Devaraj A, Brain KE, Eisen T, Gosney J, Green, BA, Holemans J, Kavanagh T, Kerr KM, Ledson M, Lifford K, McRonald FE, Nair A, Page R, Parmar MKB, Rassl D, Rintoul RC, Screaton N, Wald NJ, Weller D, Williamson PR, Yadegarfar G, Hansell DM. United Kingdom Lung Cancer RCT Pilot Screening Trial (UKLS): Baseline findings from the screening arm provide evidence for a cost effective exemplar for implementation of lung cancer screening. Thorax 2015;0:1–10.

Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) - protocol for a prospective longitudinal test accuracy study to validate new risk scores in women with symptoms of suspected ovarian cancer. Sundar S, Rick C, Dowling F, Au P, Snell K, Talapadi NR, Champeneria R, Stobart H, Neal RD, Davenport C, Mallett S, Sutton A, Kehoe S, Timmerman D, Bourne T, Van Calster B, Menon U, Deeks J. BMJ Open 2016;6:e010333. doi: 10.1136/bmjopen-2015-010333 

Elwyn G, Pickles T, Edwards A, Kinsey K, Brain K, Newcombe RG, Firth J, Marrin K, Nye A, Wood F. Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: a stepped wedge trial. Patient Education and Counseling. Patient Educ Couns. 2016 Apr;99(4):571-7. doi: 10.1016/j.pec.2015.10.011. 

Hughes DL, Neal RD, Lyratzopoulos G, Rubin GP. Profiling for primary care presentation, investigation and referral for liver cancers – evidence from a national audit. European Journal of Gastroenterology and Hepatology. 2016 28(4):428-32.

Lifford KJ, Witt J, Burton M, Collins K, Caldon L, Edwards A, Reed M, Wyld L, Brain K. Understanding older women’s decision making and coping in the context of breast cancer treatment. BMC Informatics and Medical Decision Making 2015; 15:45DOI 10.1186/s12911-015-0167-1.

Evaluating a computer aid for assessing stomach symptoms (ECASS): study protocol for a randomised controlled trial. Moore HJ, Nixon C, Tariq A, Emery J, Hamilton W, Hoare Z, Kershenbaum A, Neal RD, Ukoumunne OC, Usher-Smith J, Walter FM, Whyte S, Rubin G. Trials, 17:184. 2016. DOI: 10.1186/s13063-016-1307-3

Women's perspectives on human papillomavirus self-sampling in the context of the UK cervical screening programme. Williams, D., Fiander, A., Davies, M., Farewell, D., Hillier S., Brain, K. Health Expectations 10.1111/hex.12544

Smits, S, Boivin, J, Menon, U, Brain, K. The double edged sword of ovarian cancer information for women at increased risk. Ecancermedicalscience. 2016; 10: 650. Published online 2016 Jun 30. doi:  10.3332/ecancer.2016.650

Neal RD, Robbé IJ, Lewis M, Williamson I, Hanson J. The complexity and difficulty of diagnosing lung cancer: findings from a national primary care study in Wales. Primary Health Care Research & Development. Prim Health Care Res Dev2014 Dec 8:1-14. DOI:10.1017/S1463423614000516

McCutchan G, Wood F, Smits S, Edwards A, Brain K. Barriers to cancer symptom presentation among people from low socioeconomic groups: a qualitative study. BBMC Public Health (2016) 16:1052 DOI 10.1186/s12889-016-3733-2

Smits S, McCutchan G, Wood F, Edwards A, Lewis I, Robling M, Paranjothy S, Carter B, Townson J, Brain K. Development of a behaviour change intervention to encourage timely cancer symptom presentation among people living in deprived communities using the Behaviour Change Wheel. Ann Behav Med. (2016). doi:10.1007/s12160-016-9849-x

Nafees Din, Andrei Stanciu, Ruth Lewis, Richard Neal, Eila Watson, Clare Wilkinson. Patient perspectives and quality of life issues whilst undergoing intermittent or continuous androgen deprivation therapy for prostate cancer: a mixed methods systematic review. PROSPERO 2016:CRD42016046503 (PRIME)

Parsonage RK, Hiscock J, Law RJ, Neal RD. Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data. Br J Gen Pract. 2016 Nov 21. pii: bjgpjan-2017-67-654-neal-fl-p. [Epub ahead of print]

Williams NH, Roberts JL, Din NU, Totton N, Charles JM, Hawkes CA, Morrison V, Hoare Z, Williams M, Pritchard AW, Alexander S, Lemmey A, Woods RT, Sackley C, Logan P, Edwards RT, and Wilkinson C. Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture. BMJ Open 2016;6: e012422. doi:10.1136/ bmjopen-2016-012422

Parsonage, R, Hiscock, J, Law, R-J and Neal, R (2016) Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data. Br J Gen Pract. 2017 Jan;67(654):e49-e56. doi: 10.3399/bjgp16X688357.

Watson E, Shinkins B, Frith E, Neal D, Hamdy F, Walter F, Weller D, Wilkinson C, Faithfull S. Wolstenholme J. Sooriakumaran P, Kastner C, Campbell C, Neal RD, Butcher H, Matthews M, Perera R, Russell S, Rose P. Symptoms, unmet needs, psychological well-being and health status in prostate cancer survivors: implications for redesigning follow-up. BJU Int. 2016 Jun;117(6B):E10-9. doi: 10.1111/bju.13122.

Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Tudor Edwards R, Neal RD, Wilkinson C. A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol. MJ Open 2015;5:e008470 doi:10.1136/bmjopen-2015-008470