Remembering Professor Jane Wardle – Part 2 – Bowel cancer screening

In the second in our series on Professor Jane Wardle’s contribution to cancer behavioural science, Dr Christian von Wagner and Dr Sam Smith write about the impact that Jane’s work has had on bowel cancer screening.

Screening for bowel cancer prevention and early detection

Jane’s impact on the field of bowel cancer screening was immeasurable. Bowel Cancer Screening is unique in offering many different types of potential modalities to facilitate population based testing. All of them offer important public health benefits, but also present considerable challenges to their prospective users.  Jane was at the forefront and a pioneer into much needed research on identifying determinants of uptake. One of her major legacies includes her extremely successful collaboration with Professor Wendy Atkin on the landmark trial of Flexible Sigmoidoscopy which paved the way to what is now known as the ‘Bowel Scope Screening Programme’.  Implementation of this programme has the potential to reduce bowel cancer mortality by over 40%.

Another very important area of work emerging from this time was to document and better understand socioeconomic inequalities in screening uptake. Jane was one of the first to warn that with the benefits of new screening programmes (as with any other health innovation) comes the danger of widening already existing inequalities in health outcomes. She described this both for participation in the UK Flexible Sigmoidoscopy Trial and the completion of the home-based test kit used in the current Bowel Cancer Screening programme.  Importantly, she went on to develop the first set of national interventions to reduce the social gradient in screening uptake using evidence based strategies.

This research has many components, including the largest trial of GP endorsement of a bowel cancer screening programme to date and the development of an enhanced reminder letter which successfully reduced socioeconomic inequalities in uptake. With this work Jane was able to inspire and lead a team of world renowned experts, many of whom had not previously worked together. As a result, there are now important publications on how to design very large public health trials into reducing socioeconomic inequalities and many excellent papers on the development and testing of evidence based and highly imaginative public health interventions that were cost free and easily implementable.

Going forward Jane will be sorely missed when trying to tackle future challenges in bowel screening.  Her unique combination of pragmatism, ingenuity and her ability to rally both public and health professionals alike will be particularly missed when trying to implement the new Bowel Scope Screening Programme. Jane’s passion and enthusiasm for the topic is lost, but her colleagues and students, whom she so brilliantly mentored over her unequaled career, are determined to continue her legacy.