by Amen Sanghera
Recently I read that cancer was discovered in a 1.7 million year old ancient human fossil.1 This discovery sparked my interest to understand some of the more recent developments in cancer research and the importance of early diagnosis in successfully treating cancers. Since the 1970s the survival rates for cancer have doubled, with 50 per cent of people diagnosed with cancer now surviving their disease for ten years or more.2
However, despite decades of research and considerable investment at a global level, cancer remains a pervasive challenge that will affect all of us in some way at some point in our lives. It is estimated that in the UK alone:
- there are more than 360,000 new cancer diagnoses every year
- there are around 164,000 cancer deaths every year
- one in two of us will be diagnosed with cancer at some point in our life time up from one in three only five years ago
- and around 4 in 10 UK cancer cases every year could be prevented.3
These stats alone are startling. However, across the world cancer the incidence of cancer is increasing. In 2012 there were 14.1 million new cases of cancer, and in 2030 it is estimated that there will be 23.6 million new cases worldwide.4 We know that a key reason for the rising incidence rates is due to lifestyle choices such as smoking, poor diet and a lack of exercise. We also know that although cancer can occur at any age, the risk of developing cancer increases with age, with half of all cancer cases in the UK each year diagnosed in people aged 70 or over.5 As life expectancy for people around the world increases the prevalence and incidence of cancers will also increase.
At the same time improvements in our ability to detect and treat cancers is resulting in more people living longer with cancer and many more people surviving it. Indeed, worldwide almost 32.5 million people diagnosed with cancer within the previous five years were still alive in 2012.6
Crucially important to improving cancer survival rates is the early detection and diagnosis of the disease. The more advanced the cancer the greater the difficulty in treating it successfully. For example:
- nine in ten people diagnosed with stage one bowel cancer survive five years or more, whereas at stage four only one in ten survive
- four in ten people diagnosed with stage one lung cancer survive five years or more, whereas at stage four only one in ten survive.
However, implementing and encouraging people to best utilise the services that are currently available for early diagnosis is complicated. For example, while the UK runs a number of national cancer screening programmes, these programmes are underutilised. Indeed, in 2017 the percentage of women participating in breast cancer screening was at the lowest level for a decade, dropping to 71 per cent of women.7
Our 2013 report, Working differently to provide early diagnosis, highlighted the compelling quality and cost arguments for improving access to early diagnostics and the organisational, financial, operational and cultural obstacles that needed to be addressed for the UK to improve the efficiency and effectiveness of its diagnostic services. Since our report, there have been numerous local and national initiatives aimed at improving access to earlier diagnosis. Some local examples include:
- the use of mobile scanning trucks. In Manchester these trucks were able to pick up one cancer for every 33 patients scanned over one year8
- in West London high resolution MR scanning reduced the average diagnosis time for prostate cancer from 56 days (following referral) to eight days.9, 10
However, to achieve faster and earlier cancer diagnoses at scale, NHS England is also looking to change the way it tackles cancer by introducing new models for care, rapid diagnosis centres, new diagnostic tests and cancer awareness campaigns. Some of these initiatives are occurring now while others are expected to be rolled out across England over the next three years. These initiatives include:
- new models of care - in 2016 and over a period of two years, NHS England made more than £200m available to Cancer Alliances to help develop new models of care that will transform services by speeding up diagnosis. One such model, known as the Accountable Cancer Network (ACN), aims to deliver a coordinated approach to cancer care, looking at prevention and education as well as early diagnosis and treatment. The ACN serves a population of over ten million people and is led by three NHS foundation trusts; The Christie, The Royal Marsden and University College London Hospitals.
- new diagnostics test - from 2018, NHS England will introduce a new bowel cancer screening test for over four million people. The faecal immunochemical test for haemoglobin (FIT) can be self-administered and is expected to increase the uptake of bowel cancer screening by around seven per cent. From April 2019 a new cervical cancer screening programme will be introduced, testing for Human papilloma virus (HPV) - the cause of 99 per cent of cervical cancers. The introduction of primary HPV testing for cervical cancer will see more than three million women a year tested and could prevent around 600 cases a year.
- rapid diagnostic and assessment centres - the NHS Five Year Forward View Next Steps document calls for the introduction of ten new multidisciplinary rapid diagnostic and assessment centres across England. Currently nine out of the ten centres have been set up. The centres are composed of multidisciplinary clinical teams that specialise in the diagnosis of cancers and accept case referrals from GPs, hospitals doctors, radiologists and other health care professionals. Cancer Alliances are also establishing their own centres targeting specific cancers such as prostate. The aim being to provide patients with faster and higher quality care, and ease diagnostic pressures on primary and secondary care services.
- 28 day faster diagnosis standard - a new cancer diagnosis standard, designed to ensure that patients find out within 28 days whether or not they have cancer, will be introduced in 2020. Five sites are already piloting the new 28-day standard across six cancer specialties, including gynaecology, urology, head and neck, lung, lower and upper gastrointestinal.
- developing the cancer workforce - in 2017 Health Education England (HEE) launched its 2021 Cancer workforce plan.11 The plan sets out how it will make sure the NHS has enough staff with the right skills to deliver improvements for people affected by cancer over the next three years. It also includes plans for the recruitment of additional specialist staff, including 200 extra clinical endoscopists and 300 reporting radiographers.12
While there is clearly widespread acknowledgement of the need to improve diagnostic services, early diagnosis remains an area that continues to challenge the NHS. While the NHS clearly has an important role, this is not just about the services that are available, but the timeliness and extent to which patients optimise their use of the services. As noted above, one in two of the population will experience cancer in their lifetime. The general public therefore needs to play its part and involve themselves in the discussion. We all need to work on removing the taboo of speaking about cancer, continue to educate ourselves on the symptoms and causes of common cancers and fully utilise the services that are available to us now.