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OBJECTIVE: To test the efficacy of education by home letter, together with improved specialist/GP liaison, in promoting the detection of treatable gastro-oesophageal cancer in patients over 40. DESIGN: Prospective non-randomized trial with matched control group. PARTICIPANTS: 37,500 individuals over 40, registered with 12 general practices, were sent yearly letters for 3 consecutive years, advising them to consult a doctor with 4 specific symptoms. A matched control population of 60,500 received no intervention. MAIN OUTCOME MEASURES: Cancer cases were identified from cancer registry data, and the stage distribution and operability rates calculated from review of hospital case notes. RESULTS: Twenty of 59 cancer patients in the study group (34%) and 42 of 125 in the control group (34%) underwent resections; 24% (14/59) of study group and 18% (23/125) of control patients had "curable" disease (odds ratio [OR]= 1.51 [95%CI 0.71-3.23], X(2) = 1.164, P = 0.28). In year 1 of the study, 11 of 20 (55%) study group patients underwent resection compared to P 10 of 38 (26%) control group patients (P = 0.045, Fisher's exact test, OR = 3.4 [95% CI 1.09-0.7]). In year 1, 8 of 20 study patients (40%) had "curable" disease compared to 10.5% (4/38) control patients (P = 0.0128 Fisher's exact test, OR = 5.67 [95% CI 1.44 - 22.3]). There was no difference in survival between the groups overall or on comparing each year of study. CONCLUSION: This intervention caused a transient marked improvement in resection rate and curability, but the longer term impact on stage and resection rate was nonsignificant, and survival was not affected. Improving the detection of curable upper GI cancer is likely to require more complex and intensive interventions.

Original publication




Journal article



Publication Date





154 - 161


Academic Unit of Surgery, Department of Civic Design, Clinical Sciences Centre, University Hospital Aintree, University of Liverpool, Lower Lane, Liverpool L9 7AL, UK.


Humans, Esophageal Neoplasms, Stomach Neoplasms, Registries, Survival Analysis, Education, Medical, Continuing, Adult, Aged, Aged, 80 and over, Middle Aged, Physicians, Family, Professional Practice, Female, Male