Cancer and Primary Care

Bowel Star UK: evaluating the introduction of risk stratification within the English and Scottish bowel cancer screening programmes

Principal investigator: Professor David Weller

Bowel Star UK is a Cancer Research UK study evaluating the introduction of risk stratification within the English and Scottish bowel cancer screening programmes running between 2024-2029. This programme of work seeks to examine whether the existing NHS National Bowel Screening programme could save more lives by making better use of the test.

‘Risk-based screening’ can increase the identification of early bowel cancer through screening of those who are most likely to be at high risk. So instead of the Faecal Immunochemical Test producing a ‘yes-no’ answer, the study will use its whole range of values in deciding what further tests (if any) are needed. The study will also examine other risk factors such as family history, genetics and health-related behaviours to see how they might lead to further improvements in screening performance and patient outcomes.

The acceptability of these approaches to the UK general public will be explored through qualitative interviews. Bowel Star UK will also evaluate the impact on the NHS screening programmes in terms of cost and health inequalities.

Visit the Bowel Star UK project page

HPV Equity study: exploring strategies to enhance cervical cancer prevention accessibility in Scotland for vulnerable groups for vulnerable groups (HPV Equity)

Principal investigator: Dr Christine Campbell

HPV Equity is a multi-component study focussing on cervical cancer prevention services for inclusion health populations in Scotland, specifically individuals with experience of homelessness, transactional sex, substance addiction/use, or living in custody.  

These populations are at the extreme end of the socioeconomic gradient of health inequalities, experiencing significant social marginalisation and facing many interpersonal, structural, and system barriers to accessing primary and secondary healthcare services. Moreover, they have lower Human papillomavirus (HPV) vaccination rates, lower uptake and engagement with cervical cancer screening programmes, and are also at higher risk of developing cervical cancer following HPV infection.

The study comprises four broad components: 

1. Baseline HPV testing to assess the type-specific prevalence of HPV in our study population.
2. The provision of opportunistic HPV vaccination during routine sexual health clinics to assess the feasibility, uptake and course completion of this form of service provision.
3. Qualitative exploration of the perspectives of women from our study population on HPV vaccination and cervical screening.
4. A systematic review of international clinical guidelines relating to HPV vaccination and cervical screening for women with experience of transactional sex, homelessness, living in custody, or substance use/addiction. 

The study is underway in three regions of Scotland: NHS Lothian, NHS Greater Glasgow and Clyde, and NHS Grampian. We are conducting opportunistic vaccination and swab collection in prisons, specialist sexual health clinics, and as part of community outreach services.

NCD-Connect: strengthening healthcare in rural Malawi through integration of screening for non-communicable diseases in cervical cancer screening clinics

Principal investigator: Dr Christine Campbell

This eighteen-month project is funded by the Scottish Government International Development Fund, and running from early 2026 to mid-2027. The co-leads are Dr Christine Campbell and Mrs Kabota (Nkhoma Hospital, Malawi), together with Dr Mia Closs, Dr Lauren Ng, Dr Themba Mzilahowa, and in partnership with the Malawi Non-Communicable Diseases Alliance. 

The project aims to assess the feasibility of undertaking non-communicable disease (NCD) screening -including blood pressure, blood sugar, clinical breast examination- for women presenting for cervical screening, and to pilot NCD screening in hospital and health centre screening clinics, using existing and developed sensitisation materials.

Working with the Malawi Ministry of Health Non-Communicable Disease department, training materials will be developed, focusing on NCD burden, screening tools, approaches, and management pathways for women aged 25-49 years attending cervical screening, contextualised for the challenges of rural healthcare. These materials will be implemented at nine sites, raising awareness of NCDs in local communities. NCD screening will be offered to eligible women, and outcomes and impact will be evaluated.

CerCa Malawi study: exploring women’s beliefs and influences that affect participation in cervical cancer screening in Malawi

Principal investigators: Dr Christine Campbell and Dr Mia Closs

This qualitative study, funded by the Scottish Funding Council International Science Partnership Fund was carried out together with research colleagues at Kamuzu University of Health Sciences and the Centre for Health, Agriculture and Development Consultancy in Malawi from 2025 - 2026. The Principal Investigator Dr Christine Campbell, with co-investigators Dr Mia Closs, Dr Themba Mzilahowa and Mrs Beatrice Kabota worked with input from the Malawi Women’s Coalition Against Cancer.

The study explores women’s perspectives on cervical cancer and HIV, the double burden of disease, as well as stigma and partner support, among women in rural Malawi. Sixteen focus group discussions were held at village sites across all three regions of Malawi, eight with women who received cervical screening and eight with women who had not participated in cervical screening. Focus group discussions were recorded, translated, transcribed, and analysed. A more nuanced understanding of women’s experiences of cervical screening and contexts is informing development of culturally-sensitive interventions to improve women’s health.

Community-Led Engagement And Research- VOices In Cancer and Everyday primary care (CLEAR VOICE)

The Cancer and Primary Care research group recognises the importance of inclusive research and ensuring that our work reflects the needs and priorities of people with lived experience of cancer from diverse backgrounds. This University of Edinburgh College of Medicine and Veterinary Medicine Impact funded project aims to engage with the local Craigmillar community and establish partnerships with local primary care practices to develop a sustainable patient and public involvement group that can inform and shape our ongoing research.

COMPASS (Cancer outcomes in multimorbidity: pathway and systems study): exploring how pre-existing multimorbidity influences the cancer diagnosis journey and impacts patient outcomes

Principal investigator: Dr Susanne Maxwell

Multimorbidity is common at cancer diagnosis and can influence screening uptake, route to diagnosis, treatment decisions and survival. Understanding how the presence, type and complexity of long-term conditions shape cancer diagnostic journeys can identify patients at risk of delay, reveal mechanisms such as symptom masking or competing priorities, and inform interventions to shorten diagnostic intervals. This PhD will use a multi-methods design to explore how multimorbidity, measured in multiple ways, impacts cancer diagnostic pathways and outcomes.

BOWEL MAPS study (BOWEL screening – Mapping and Analysing Participation and Spatial disparities): examining how spatial, individual, and contextual factors interact to influence disparities in bowel screening participation in Scotland

Principal investigator: Dr Lauren Ng

Bowel cancer screening has the lowest uptake of all screening programmes in Scotland. Furthermore, not all groups participate equally. Increasing evidence suggests that where people live plays an important role, although this remains poorly understood in the UK. 

This PhD will apply a multi-level framework to examine how individual, environmental, and psychological-behavioural factors interact to influence participation in bowel screening. The work will focus on identifying spatial patterns of participation across the full screening pathway, and on understanding how these patterns relate to both place-based and individual determinants.

Post-treatment breast cancer survivorship care in Pakistan: understanding the current landscape and opportunities for integrated and supportive models

Principal investigator: Ayesha Bibi

This PhD examines breast cancer survivorship in Pakistan and informs the development of context-specific models to improve post-treatment care through integrated, multidisciplinary approaches.

The impact of socioeconomic position on survival outcomes in pancreatobiliary cancers

Principal investigator: Sofia Rodriguez Moussaoui

This PhD investigates how socioeconomic status affects the survival of people with pancreatobiliary malignancies living in Scotland.

Adherence to Recommended Treatment and Loss to Follow-up among Women with Positive Cervical Screening Results in Kenya: A Mixed Method Study

Principal Investigator: Yvonne Fondo

This research investigates the levels of, factors associated with, and reasons for, nonadherence to recommended treatment and loss to follow-up among women with positive cervical screening results (regardless of screening modality) in primary and secondary health facilities in Kenya. This study will employ a mixed methods approach including a systematic review, quantitative data analyses of recent and current adherence and follow-up patterns, and a qualitative exploration of attitudes of screening participants.

Facilitating access to cervical screening for vulnerable patients - the experiences of practice nurses (REACH OUT)

Principal investigators: Dr Mia Closs and Dr Christine Campbell

Cervical screening remains an essential element in cervical cancer prevention, with the majority of cervical smears (in the UK) taken in general practices by practice nurses. While excellent professional guidance is available on general screening practice and sample taking, there is little in the literature to better understand the experience of practice nurses in supporting vulnerable populations around cervical screening participation.

The aim of REACH OUT was to understand practice nurses’ experience of delivering cervical screening for vulnerable, minority and marginalised populations in Scotland. We undertook discussion groups with practice nurses across Scotland. Participants were based in a mix of urban, remote, rural, inner city, and deep end practices.

The project team are analysing the data from this study, but early results indicate three superordinate interrelated themes: time, opportunity, relationships.

Feasibility study: examining how lung cancer screening could be implemented in Scotland (LUNGSCOT)

Principal investigator: Dr Debbie Cavers

The LungScot study was funded by the Chief Scientist Office and Scottish Government, running from 2022-2024. The study was a small-scale feasibility and acceptability study examining how lung cancer screening could be implemented in Scotland, with particular interest in Scotland’s unique setting incorporating urban, rural, and remote populations, and areas with high socioeconomic deprivation. It involved offering a low dose computed tomography scan to high-risk individuals identified in participating general practices across four Health Boards in Scotland. Feasibility, acceptability and influences on participation were explored through qualitative interviews with participants, non-responders and primary care professionals.

Moving Towards Sustainability: implementation and roll-out of cervical cancer ‘Screen and Treat’ services across rural Malawi’ (MALSCOT)

Principal investigator: Dr Christine Campbell

This project, funded by the Scottish Government International Development Fund, and delivered in partnership with Nkhoma Hospital in Central Malawi, ran from 2018-2024. The Principal Investigator was Dr Christine Campbell, with co-lead Professor Heather Cubie (University of Edinburgh Honorary Global Health Consultant) and national coordinator Mrs Beatrice Kabota. Malawi has the highest global cervical cancer mortality, and the Malawi Ministry of Health’s National Cervical Cancer Strategic Plan 2022 – 2026 supports cervical screening with either Visual Inspection with Acetic acid (VIA) or Human papillomavirus (HPV) testing, in line with the World Health Organization’s Global Strategy on cervical cancer elimination. 

The aim was to implement a sustainable programme of same day ‘screen and treat’ programme of cervical screening using VIA, thermal ablation for immediate treatment, and robust follow-up pathways. Partnership working between Malawian and Scottish clinical colleagues has enabled screening provision in 8 hospitals and 42 associated health centres across Malawi following facility assessment, sensitisation of local leaders and communities, refurbishment of screening rooms and equipping with standard instruments. Screening clinics liaise closely with antiretroviral therapy clinics. Initiatives have been set up to reach vulnerable groups, working with local advocacy groups. Mentoring and ongoing Continued Professional Development and peer support have been critical to the success of the programme. 

Competence-assured VIA proved to be feasible, effective and sustainable, and has provided the framework for a sustainable programme, until an affordable point-of-care test for HPV is available at scale within Malawi.

Understanding and addressing variation in cervical screening in Scotland (SCREEN)

Principal investigator: Dr Christine Campbell

SCREEN was a multi-component project aiming to describe and understand variations in cervical screening participation in minority ethnic populations in Scotland, so as to better support access to screening services. We undertook:

1. A systematic review of evidence on approaches to increasing cervical screening uptake among women from ethnic minority populations in high-income countries.
2. An in-depth qualitative study with comparison groups from four minority ethnic populations and the majority white Scottish population, exploring the experiences of participating, and not participating, in cervical screening.
3. A data linkage study aiming to identify and describe variations in cervical screening participation by ethnicity and socio-demographic variables in the Scottish population

Overall, the project identified that, based on data linkage, there were important variations in screening uptake between ethnic populations in Scotland. However, the qualitative work illustrated that many screening experiences were common regardless of ethnicity with key differences, arising within and across groups, between individuals who grew up in Scotland and individuals who came to Scotland as adults. The systematic review found that, while many interventions designed to promote screening uptake in minority ethnic populations were associated with an increase in intention or actual uptake of cervical screening, the quality of the evidence was low and the heterogeneity of the interventions made it difficult to assess the effectiveness of individual intervention functions.

Multimorbidity in sub-Saharan Africa: Focusing on the National Prevalence and the Response of Primary Care in Botswana

Principal investigator: Dr Mpho Refilwe Disang

Sub-Saharan Africa faces a “double burden” of diseases. This PhD investigated multimorbidity; the coexistence of two or more chronic conditions in an individual, with a focus on the intersection of communicable diseases such as HIV, and other chronic illnesses. Using a convergent mixed-methods approach, the study synthesised regional evidence through a systematic review, analysed nationally representative data from the Botswana Demographic Survey, and engaged directly with healthcare workers and policymakers through in-depth interviews. The findings highlight the rising burden of chronic diseases and the need for more integrated primary healthcare services. The PhD was fully sponsored by the University of Botswana and awarded in 2024.

Other past projects

• National Cancer Diagnosis Audit: exploring pathways to cancer diagnosis in Scotland through primary care
• Improving access to cancer screening among people with intellectual disabilities: development of a complex intervention
  • Christine Campbell and David Weller were co-investigators for this project, based at the University of Glasgow and led by Professor Katie Robb.
• Prevention and Screening Innovation Project towards Elimination of Cervical Cancer (PRESCRIP-TEC)

• Maxwell S, Weller D, Dennison B, Taylor L, Miles H, Cairns J, Von Wagner C, Smith J, Usher-Smith J. Stratified/risk-based screening for colorectal cancer in the UK: an overview. Colorectal Cancer. 2025 May 20;14(1):2501851. doi: 10.1080/1758194X.2025.2501851
• Nazrul N, Rahman A, de Fouw M, Campbell C, Koot J, Kulsum MU, Ahmed MS, Haider SS, Hossain MA, Islam KM, Nessa A, Amrin M, Stekelenburg J, Beltman JJ. Cervical high-risk human papillomavirus infection and its associated risk factors: a community-based cross-sectional study in hard-to-reach areas in Bangladesh. BMJ Open. 2025 Dec 18;15(12):e103915 doi: 10.1136/bmjopen-2025-103915
• Ashcroft T, Fleetwood K, Campbell C, Jackson CA. Cancer Incidence Among People With a Prior Hospital Record of Depression in Scotland, 1991-2019: A Cohort Study. Cancer Med. 2025 Jan;14(1):e70496. doi: 10.1002/cam4.70496
• Cavers D, Cunningham-Burley SC, Watson E, Banks E, Campbell C. Living with and beyond cancer with comorbid conditions: qualitative insights to understand psychosocial support needs. Health Expect. 2024;27(5):e70039. doi: 10.1111/hex.70039
• Maxwell S, Kynn M, Weller D, Anderson LA, Murchie P. Revisiting cancer diagnosis in Scotland: further insights from the second Scottish national cancer diagnosis audit. Eur J Cancer Care. 2024;33(1):e1117968. doi: 10.1155/2024/1117968
• Maxwell S, Pearce C, Kynn M, Anderson LA, Weller D, Murchie P. The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: Further results from a national cancer diagnosis audit. Cancer Epidemiol. 2023 Oct;86:102414. doi: 10.1016/j.canep.2023.102414
• Cavers D, Closs (Nelson) M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJ, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimising the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect. 2022;25(6):3246-3258 doi: 10.1111/hex.13632
• Cavers D, Campbell C, Brewster D, Weller D, Bikker A, Kanguru L, Barnett K, Duff R. Patient and GP experiences of pathway to diagnosis of a second primary cancer. BMC Cancer. 2021. doi: 10.1186/s12885-021-08238-0
• Closs (Nelson) M, Patton A, Robb K, Weller D, Sheikh A, Ragupathy K, Morrison D, Campbell C. Experiences of cervical screening participation and non-participation in women from minority ethnic populations in Scotland. Health Expect. 2021 Aug;24(4):1459-1472. doi: 10.1111/hex.13287
• Campbell C, Sommerfield T, Clark GRC, Porteous L, Milne AM, Millar R, Syme T, Thomson CS. COVID-19 and cancer screening in Scotland: A national and coordinated approach to minimising harm. Prev Med. 2021 Oct;151:106606. doi: 10.1016/j.ypmed.2021.106606. Epub 2021 Jun 30. PMID: 34217418; PMCID: PMC8241681.