Jo Waller

Introduction: Non‐endoscopic capsule sponge devices are a promising new technology. They could potentially improve oesophageal cancer outcomes by detecting and monitoring Barrett's oesophagus and identifying dysplasia early to allow timely treatment. Trials assessing their clinical utility are underway. Objective: This study sought to understand potential barriers and enablers to capsule sponge screening among people with heartburn. Methods: Forty semi‐structured interviews were conducted between October 2024 and April 2025 with men aged 55–79 and women aged 65–79 taking regular reflux medication. Participants were purposively sampled. Transcripts were analysed using Thematic Framework Analysis. Results: Participants were generally enthusiastic about the test, but not all felt willing or able to take part. Key factors influencing their attitudes are described in three overarching themes. First, participants described how they navigate reflux‐related care and negotiate this with healthcare professionals. They considered how capsule sponge screening would fit into this collaborative model. Second, participants showed an aversion to uncertainty, noting that capsule sponge screening could both create and reduce uncertainty about their health. Third, participants' understanding of their candidacy varied based on risk perceptions, self‐efficacy and views about acting on test results. Some expressed a sense of being less ‘worthy’ candidates than others. Conclusion: Overall, the capsule sponge test screening appealed to many due to its quick, simple and minimally invasive approach. Nevertheless, concerns about responsibility for reflux care, candidacy and uncertainty will likely shape attitudes and intention towards the test and should be key considerations if this test is implemented. Lived Experience or Public Contribution: Three individuals with lived experience of reflux, Barrett's oesophagus and oesophageal cancer were involved in the design of this study and associated materials.

Objective: Offering individuals with gastro-oesophageal reflux a non-endoscopic capsule sponge test increased detection of Barrett’s oesophagus (BO), a precursor to oesophageal adenocarcinoma. However, only 24% of individuals identified through general practitioner (GP) records participated. We therefore performed an implementation study to assess the feasibility of screening on a mobile unit and screening uptake among GP-invited and self-referred individuals. Methods: In this implementation study, 3293 individuals aged ≥50 with a repeat proton pump inhibitor prescription were invited to participate by their GPs across three GP practices in the East of England between June 2021 and January 2023. Additionally, we advertised the study and allowed self-referrals. Eligibility was assessed based on age and reflux history. Eligible individuals were invited to an appointment. Acceptability was assessed after the appointment. Individuals with a positive capsule sponge test were referred for endoscopy. Results: Half of the GP-invited individuals responded, of whom 59.6% (n=952/1598) were interested. Among interested individuals who could be contacted, 66.3% (n=574/866) were eligible, and 532 participated. Of these, 502 (94%) successfully swallowed a capsule sponge, representing 15% of those invited and 87.5% of eligible individuals. Among 468 individuals who self-referred and could be contacted, 48.5% (n=227) were eligible, 217 participated, and 208 (96%) successfully swallowed a capsule sponge (39.6% of self-referred, 91.6% of eligible individuals). 9.4% (n=47/502) of GP-invited and 12.0% (n=25/208) of self-referred individuals were referred for endoscopy, with 4.2% (n=21/502) and 3.4% (n=7/208), respectively, diagnosed with BO (positive predictive value of endoscopy referral=42.4%), including three with dysplasia. Over 99% of participants said the capsule sponge test was acceptable. Conclusion: Screening on a mobile unit is feasible. Identifying individuals at increased risk of BO from GP records is feasible, and encouraging self-referrals increases uptake. BO prevalence was similar among eligible participants who self-referred and those identified through GP records. Trial registration number: ISRCTN91655550 .

Objectives: Cancer screening is crucial for early detection and improved outcomes globally. Screening must be “acceptable” to health professionals and the public. However, acceptability definitions and measures have not always been made explicit. This scoping review aimed to explore the definitions, theories, and methods used by researchers investigating acceptability. Methods: We conducted a term‐based scoping review of published literature in six databases. Two independent reviewers screened citations for inclusion. Study characteristics (publication year, country, study design, sample size, population, methodological characteristics), characteristics of acceptability (definition, theory, test or device), and screening context (cancer type, screening procedure) were extracted by one author and checked independently by a second author. Results were reported descriptively. Definitions and operationalisations of acceptability were analysed through content analysis. Results: We identified 393 studies, largely published after 2013. Most examined patient or public attitudes towards self‐sampling for cervical screening. Few studies cited theory ( n = 55, 14%) or provided a definition of acceptability ( n = 17, 4.3%). Acceptability was typically defined as a multidimensional construct or as perceptions or attitudes towards screening. Studies operationalised acceptability most often as physical side‐effects ( n = 68, 42.8%), willingness to attend screening ( n = 59, 29.4%), screening method preference ( n = 55, 27.4%), ease of use ( n = 52, 25.9%), and general attitudes ( n = 51, 25.4%). Conclusions: Research focussed on acceptability in cancer screening has not been based on theory and uses a range of operationalisations, including loosely related constructs such as uptake. A specific definition of acceptability in cancer screening and reporting guidelines for interdisciplinary research are needed to support evidence‐based decision‐making.

As decisions are made worldwide about the best way to adapt cervical screening to cohorts and individuals who have been offered human papillomavirus (HPV) vaccination, we consider the issues this raises for communication. This article reviews the relevant literature on knowledge and awareness of HPV, lessons we can learn from emerging evidence on attitudes to risk-adapted cancer screening, and what the psychological literature tells us about the complex relationships between risk perceptions and behavior. We highlight the need to ensure communication strategies do not create or widen social inequalities. We conclude that there is a strong need for public education about the relationship between HPV, vaccination, screening, and cancer outcomes, an imperative for timely and transparent communication about the rationale for any proposed changes, a need to involve health-care professionals in supporting women to understand the changes, and a strong case for ongoing research and evaluation as changes are implemented.

OBJECTIVE: Cervical cancer is preventable through screening, yet UK attendance has declined. International studies suggest lower participation among women with excess weight. Whether this applies in the UK, and whether awareness of excess weight as a cancer risk factor relates to screening behaviour, remains unclear. METHODS: Data were analysed from screening-eligible women (N=1,345) within the September 2023 Cancer Research UK Cancer Awareness Measure “plus” (CAM+) survey. Logistic regression examined associations between body mass index (BMI) category and cervical screening attendance, adjusting for sociodemographic factors. Reported barriers were compared across BMI categories. Prompted and unprompted knowledge of excess weight as a cancer risk factor was assessed and examined in relation to BMI and attendance. RESULTS: Odds of participation were lower among women with overweight (OR=0.89, 95% CI 0.63-1.26) and obesity (OR=0.83, 95% CI 0.58-1.19) compared with healthy weight, but associations were not statistically significant. Barriers (e.g., pain, embarrassment) did not differ by BMI category. Knowledge of excess weight as a cancer risk factor was higher when prompted (77%) than unprompted (31%), but neither was associated with attendance. CONCLUSION: Excess weight was not associated with cervical screening attendance; however, small differences and international patterns suggest further research in larger samples is warranted.

Objectives Cancer screening appointments are an opportunity to encourage positive behavioural changes. Up to 80% of cancer screening attendees are open to discussing physical activity during cancer screening, but some say this would deter them from future screening. This study aimed to gain an in-depth understanding of individuals’ receptivity to physical activity advice at cancer screening. Design Interview-based qualitative study. Setting and participants The study was conducted from May 2017 to September 2018 in the UK. Participants were recruited using adverts on two university campuses, Facebook and a participant recruitment agency. To be eligible, participants had to have an upcoming cancer screening appointment within 2 weeks. There were 30 participants. Procedures Participants recorded their receptivity to physical activity advice in the days before and after screening. Data-prompted semi-structured interviews explored these responses. Interviews were analysed using a thematic framework analysis. Results Participants felt discussing physical activity at cancer screening would be relevant. However, participants experienced anxiety related to the screening process which could increase or decrease their receptivity. Participants felt if information was delivered in a judgemental way, it could negatively impact future screening participation. Conclusions Screening attendees’ receptivity could be influenced by the timing of a discussion and by their levels of anxiety throughout screening. Participants’ anxiety during screening can either reduce their ability to engage in a discussion or increase the relevance of the discussion. The communication style of the healthcare practitioner was key for why some screening attendees could be deterred from future cancer screening.