Background:National campaigns focusing on key symptoms of bowel and lung cancer ran in England in 2012, targeting men and women over the age of 50 years, from lower socioeconomic groups.Methods:Data from awareness surveys undertaken with samples of the target audience (n=1245/1140 pre-/post-bowel campaign and n=1412/1246 pre-/post-lung campaign) and Read-code data extracted from a selection general practitioner (GP) practices (n=355 for bowel and n=486 for lung) were analysed by population subgroups.Results:Unprompted symptom awareness: There were no significant differences in the magnitude of shift in ABC1 vs C2DE groups for either campaign. For the bowel campaign, there was a significantly greater increase in awareness of blood in stools in the age group 75+ years compared with the 55–74 age group, and of looser stools in men compared with women. Prompted symptom awareness: Endorsement of ‘blood in poo' remained stable, overall and across different population subgroups. Men showed a significantly greater increase in endorsement of ‘looser poo' as a definite warning sign of bowel cancer than women. There were no significant differences across subgroups in endorsement of a 3-week cough as a definite warning sign of lung cancer. GP attendances: Overall, there were significant increases in attendances for symptoms directly linked to the campaigns, with the largest percentage increase seen in the 50–59 age group. For the bowel campaign, the increase was significantly greater for men and for practices in the most-deprived quintile, whereas for lung the increase was significantly greater for practices in the least-deprived quintile.Conclusions:The national bowel and lung campaigns reached their target audience and have also influenced younger and more affluent groups. Differences in impact within the target audience were also seen. There would seem to be no unduly concerning widening in inequalities, but further analyses of the equality of impact across population subgroups is warranted.

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In vitro nucleic acid analysis has become a valuable diagnostic tool. However, in vitro measurements have many disadvantages when compared to in vivo techniques. Synthetic bacterial biosensors have been engineered to sense many target signals in vivo, but no biosensor exists to detect specific DNA sequences. Here, we engineered naturally competent Acinetobacter baylyi bacteria to detect engineered donor DNA inserted into the genomes of colorectal cancer (CRC) cells and organoids. The DNA biosensor concept was developed in vitro and then validated in vivo with sensor bacteria delivered orally or rectally to mice that had been injected with orthotopic donor CRC organoids. Horizontal gene transfer occurred from the donor tumor to the sensor bacteria in vivo, conferring antibiotic resistance to the sensor bacteria and allowing their detection in stool. The sensor bacteria differentiated mice with and without CRC. Life detecting life has many implications for future diagnosis, prevention, and treatment of disease. This approach may also be useful in any application that requires the detection of mutations or organisms within environments that are difficult to sample.

Synthetic biology has developed sophisticated cellular biosensors to detect and respond to human disease. However, biosensors have not yet been engineered to detect specific extracellular DNA sequences and mutations. Here, we engineered naturally competent Acinetobacter baylyi to detect donor DNA from the genomes of colorectal cancer (CRC) cells, organoids, and tumors. We characterized the functionality of the biosensors in vitro with coculture assays and then validated them in vivo with sensor bacteria delivered to mice harboring colorectal tumors. We observed horizontal gene transfer from the tumor to the sensor bacteria in our mouse model of CRC. This cellular assay for targeted, CRISPR-discriminated horizontal gene transfer (CATCH) enables the biodetection of specific cell-free DNA.