Accelerating childhood cancer diagnosis through the Child Cancer Smart awareness campaign
Childhood cancer continues to be a major global health challenge, with delayed diagnosis contributing significantly to poorer outcomes. As data highlight persistent diagnostic intervals and gaps in awareness, the UK’s Child Cancer Smart campaign seeks to accelerate recognition and referral, providing an evidence-based model that could help to improve survival worldwide, as paediatric emergency medicine registrar Dr Dhurgsharna Shanmugavadivel explains.
Childhood cancer is estimated to affect nearly 400,000 children globally each year.1 In the UK, one in 194 males and one in 214 females are diagnosed with cancer before their 25th birthday, and it is the leading cause of death by disease in this age group.2
Yet there is a long-standing perception that childhood cancer is rare, and this, together with a lack of awareness of the presentations, contributes to children and young people experiencing lengthy intervals to diagnosis, which can impact morbidity and mortality.
The World Health Organization (WHO) declared childhood cancer as a global disease burden in 2018 and launched the Global Initiative for Childhood Cancer (GICC) with the goal of improving survival estimates to 60% globally by 2030. If achieved, it is predicted to save the lives of an additional one million children.
The GICC has urged all countries to evaluate and make changes. However, recent European data highlighted the lack of paediatric-specific national cancer control plans, with only four of 41 countries having comprehensive paediatric oncology content.4
Early diagnosis of childhood cancers
One of the key priorities within the GICC is early diagnosis. Currently, for children and young people with cancer, symptom recognition remains the main route to early detection, as there are no viable screening options. Childhood cancer symptoms are also often non-specific, can fluctuate in intensity and mimic other more common conditions, such as migraines.
In addition, the perceived rarity and lack of awareness among both the public and healthcare professionals can lead to lengthy times to diagnosis.
Prolonged diagnostic intervals can lead to up-staging, long-term disabilities and an increased risk of mortality. The consequent need for more intensive therapies can also affect survival and life-long late effects from the treatment.
Many factors within health systems determine the speed of access to diagnosis and treatment, including public and professional awareness, access to healthcare, and access to diagnostic and treatment services.
In the UK, prioritisation of cancer screening and public awareness of adult cancers are well established and have contributed to improved outcomes, whereas public awareness of childhood cancer risk and symptomatology is low.
Building on previous success
The award-winning HeadSmart campaign, now known as Better Safe Than Tumour, was launched in 2011 to raise awareness of symptoms of childhood brain tumours in the UK.
The campaign was based on an evidence-based guideline for the assessment and investigation of suspected brain tumours and delivered professional education and public awareness of symptomatology. Associated with reducing the national median time to diagnosis for childhood brain tumours from 14.4 weeks to 6.5 weeks, the campaign demonstrated that raising awareness can be effective and powerful.
The campaign has since been recognised globally as an exemplar, encouraging investigation and action. It has also highlighted the importance of sharing evidence-based practice and reducing unnecessary replication to improve outcomes for children and young people with cancer worldwide.
The Childhood Cancer Diagnosis study
Diagnostic interval data in childhood cancer are patchy, with little standardisation of definitions across studies and no national overview. The Childhood Cancer Diagnosis (CCD) study recruited nearly 2,000 children and young people aged 0–18 years diagnosed with cancer between 2020 and 2023 and examined their routes and time to diagnosis.5
The study protocol has been published to enable other countries to conduct and compare.6
The study found that the median total diagnostic interval – the time from first symptom to diagnosis – was 4.6 weeks. The time to diagnosis also varied depending on the patient’s age and cancer type.
Young people aged 15–18 years had the longest time to diagnosis, with a median of 8.7 weeks, while infants under one year had a shorter median of 3.7 weeks.
Bone tumours took the longest to diagnose, with a median time of 12.6 weeks, whereas renal tumours were diagnosed the fastest, with a median of 2.3 weeks. Importantly, the study found no differences in diagnostic times by sex, ethnicity or socioeconomic background.
Childhood cancer awareness campaign
The Children and Young People’s Cancer Association (CCLG) recently launched Child Cancer Smart – a national public and professional awareness campaign aimed at accelerating diagnoses and improving outcomes for children and young people in the UK.
Its main goal is to help the public and healthcare professionals to identify patterns in childhood cancer that differ from other common childhood illnesses. In childhood cancer, there is persistence, progression and clusters of symptoms, depending on cancer type.
Two symptom posters accompany this message to help identify symptoms that may require further investigation. The first poster, which is organised by body part, is for families, while the second is for healthcare professionals and is organised by cancer type. These are based on systematic reviews of globally published literature and can be adapted, translated and used worldwide.
In addition, there are two distinct messages for the public and healthcare professionals about when to seek further help.
For the public, the message is to trust their parental instincts and, if symptoms persist beyond two weeks, to see their doctor.
The message for healthcare professionals is that they should ask themselves, ‘could it be cancer?’ if they see three persistent symptoms, three visits or three weeks of unexplained symptoms. If so, they should pick up the phone to initiate a potential referral.
This second message was based on data from the CCD study, which found that 50% of children and young people with solid tumours were diagnosed within three weeks, 75% had three or more symptoms at diagnosis and 75% were diagnosed within three visits. It encourages clinicians to discuss the case with their local on-call paediatrician to ensure these children and young people are seen as promptly as possible.
The Child Cancer Smart campaign trajectory
As the CCD data showed that bone tumours had the longest time to diagnosis, the Child Cancer Smart campaign has published a bone tumour guideline and a decision support tool to help healthcare professionals to identify which children and young people require further assessment and investigation.
Over the course of the campaign, more tumour-specific guidelines and decision support tools will be launched, as well as a specific campaign for young people to empower them to seek medical advice promptly.
We know that data drives change and awareness is powerful in childhood cancer. The Child Cancer Smart campaign aims to accelerate time to diagnosis for all children and young people with cancer in the UK to close existing inequalities by providing evidence-based public and professional awareness and education.
Sharing this model has the potential to accelerate diagnosis for these patients worldwide and help achieve the WHO’s ambitious survival target of 60% by 2030.
Author
Dhurgsharna Shanmugavadivel BMedSci, BMBS, MRCPCH
CCLG early diagnosis fellow, University of Nottingham, and paediatric emergency medicine registrar, Leicester Children’s Emergency Department, UK
References
- Ward ZJ et al. Estimating the total incidence of global childhood cancer: a simulation-based analysis. Lancet Oncol 2019;20(4):483–93.
- National Disease Registration Service. Children, teenagers and young adults UK cancer statistics report, 2021 [Internet]. Leeds: NHS England; 1 February 2021 [cited January 2026]. Available from:
- The Global Initiative for Childhood Cancer. WHO Global Initiative for Childhood Cancer: an overview, 2020 [Internet]. Geneva: World Health Organization;
2 November 2020 [cited January 2026]. Available from: - Prades J et al. Do national cancer control plans address care and research for children, adolescents, and young adults? A review of status, priorities, and recommendations across 41 European countries. Lancet Reg Health Eur 2025;49:101155.
- Shanmugavadivel D et al. Quantifying diagnostic intervals and routes to diagnosis for children and young people with cancer in the UK (Childhood Cancer Diagnosis study, CCD): a population-based observational study. Lancet Reg Health Eur 2025;54:101329.
- Shanmugavadivel D et al. The Childhood Cancer Diagnosis (CCD) Study: a UK observational study to describe referral pathways and quantify diagnostic intervals in children and young people with cancer. BMJ Open 2022;12(2):e058744.
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