Thanks to research, one in two people will now survive cancer for at least 10 years. That’s great news, but there is still much more to be done.
Cancer survival in the UK remains lower than the best performing countries in Europe and other parts of the world. It’s a complex picture, but a combination of later diagnoses and lower access to treatment all have a part to play.
Those differences aren’t just confined to international boundaries. Throughout the UK there is widespread variation in the proportions of cancer patients that are being diagnosed at an early stage. This is unacceptable.
Here at Cancer Research UK, one way we are determined to give more patients the best chance of survival is by finding new ways of detecting and diagnosing cancer earlier.
But detecting the disease earlier does more than saving lives. A recent report commissioned by Cancer Research UK also highlighted that earlier diagnosis could potentially help NHS resources go further. For the four cancers included in the report, the financial cost of treating an early stage cancer is nearly two-and-a-half times lower than treating the disease in its later stages.
Diagnosing cancer earlier could therefore help the NHS cope with smaller budgets, and an ageing population in which one in two people will now be diagnosed with cancer in their lifetime.
The case for prioritising earlier diagnosis is very clear, yet half of all cancers are still diagnosed at a later stage.
So what can be done?
Diagnosing cancers earlier
We must examine and improve every step leading up to a patient being diagnosed with cancer. This includes increasing public awareness and empowering people to visit their GP, while at the same time supporting GPs and improving the links between different parts of cancer care in the NHS.
The evidence produced by researchers, many of whom were at this year’s National Awareness and Early Diagnosis Initiative (NAEDI) conference, is identifying where delays are occurring and the most effective ways to address them.
A bumper selection of that work was recently published in a British Journal of Cancer supplement that focused on the early diagnosis of cancer.
Here are some examples of what we’ve learnt.
The role of health marketing campaigns
One of the ways in which delays in diagnosis are being tackled is through campaigns such as England’s Be Clear on Cancer Campaigns (BCOC) and Detect Cancer Early in Scotland. These campaigns raise awareness of potential cancer symptoms among both the public and GPs, encouraging people to visit their doctor if they notice these symptoms.
Thanks to a thorough evaluation, we know that the 2012 BCOC lung cancer campaign led to an additional 400 patients being diagnosed at an earlier stage. This is great news, and shows the impact campaigns like this can have.
Another recent study showed that people who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their GP with ‘red-flag’ cancer warning symptoms.
We also know that patients in the UK are more likely to say they worry about wasting their GP’s time when they have symptoms than elsewhere in the world. This research emphasises why campaigns designed to address barriers like these are so important.
Public awareness helps encourage people to see their GP earlier, but there are many more steps to diagnosis and treatment. And each of these present many challenges. For example, some cancers are less likely to cause obvious symptoms at an early stage, or symptoms may be vague and non-specific, making them harder to diagnose early.
This is a big challenge for GPs who, on the whole, will see very few cases of cancer in their surgeries over the course of their working life.
So how can we do more to help GPs?
Supporting GPs to spot cancer early and refer patients quickly
Primary care, most often through GPs, has a vital role in facilitating earlier diagnosis. The average GP sees hundreds if not thousands of patients with potential cancer symptoms each year. But fewer than eight new cancer cases will be diagnosed from this vast array of different people and symptoms.
We need to ensure that GPs are supported to make use of NICE referral guidelines for suspected cancer (which are not always easy to refer back to during everyday practice) and have stronger links with colleagues in secondary care. By joining up these two groups it will be easier to review cases and ensure that doctors are supporting their patients in the best way possible.
Cancer Research UK’s Primary Care facilitators are one example of how we are supporting GP practices by providing practical support to help busy practices tackle issues and take on initiatives that can help diagnose more cancers earlier.
Another way to pick up cancers earlier is to diagnose them before patients’ experience symptoms and that’s where cancer screening comes in.
Improving screening uptake
Cancer screening is an important part of the early diagnosis toolkit.
Since bowel screening was introduced in the UK, tens of thousands of people have returned the kits they receive in the post. But overall, uptake has been disappointing with less than 60 per cent of people taking part in screening in the UK. And those figures are much lower among more deprived groups.
We are piloting bowel screening social marketing campaigns in Wales (in partnership with Public Health Wales) to see if they can help build awareness of the programme and make it easier for people to take part if they want to. This builds on earlier work that took place in London, which led to some promising increases in uptake.
But changes to the bowel screening test can also help.
The UK screening programme uses a test called the faecal occult blood test – or FOBT for short – which involves collecting six small samples of faeces over a few days and posting them to a screening centre.
The somewhat lengthy process of the FOBT is likely to put some people off, which is why Cancer Research UK would like to see a different type of test known as the Faecal Immunochemical Test (FIT) being used for screening.
FIT is a better test and it’s also easier to use, requiring only one sample that’s collected with a brush and then put into a small tube of liquid. The simplicity makes people more likely to participate and most importantly includes those from deprived groups
Recently, the Scottish Government announced they will be replacing FOBT with FIT over the coming years. We’d like to see all UK nations follow Scotland’s lead and think about how they can introduce FIT as soon as possible.
The impact of the FIT highlights the difference that improvements in the diagnostic tools available can make.
So what’s in the pipeline for other types of cancer in the future?
Innovations in diagnostic tests
There’s a lot of research in this area, including work funded by Cancer Research UK.
Early stage studies looking to develop new diagnostic tests often generate significant media coverage, even if their real-life impact remains unknown, or they are a long way from being available to doctors and their patients.
Last year, this included coverage of research looking at genetic markers in blood samples that could one day estimate the likelihood that a woman may develop breast cancer. But any resulting test remains a long way off reaching the clinic. At the end of the year we also saw Google announce plans to develop ‘disease-detecting magnetic nanoparticles’. Google was simply saying it intended to start working on the concept, and is not alone in this field, but there was significant media interest nonetheless.
While these headlines are undoubtedly a long way ahead of the science, they clearly demonstrate the appetite for improving diagnostic tests.
But balancing these expectations with the real pace of research can be a challenge. And this is particularly true of developments in screening technology.
Recent research on two newer types of breast imaging show how improvements can be made. But a balance must be struck between the numbers of cancers diagnosed and treated alongside those that are spotted through screening but may have never harmed the patient. And building this type of evidence takes time.
The information must also be packaged up to ensure that everyone who is invited for screening can make their own informed decision about taking part.
Cancer Research UK has also been involved in the development of a new bowel screening device called Bowel Scope. The device can spot both early-stage cancers and pre-cancerous growths known as ‘polyps,’ which can be immediately removed to prevent them developing into cancer. We’re keen for the test to be introduced across the UK as soon as possible.
Away from the national screening programmes we are also funding important research into new diagnostics.
And ongoing research we fund has reported promising results for a test using a ‘sponge-on-a-string’ that could help diagnose more cases of oesophageal cancer earlier.
These are just a few examples of the latest developments in diagnostics technology, and innovations like these will be essential to helping diagnose patients earlier.
The UK must aim for world class cancer outcomes
There is a lot to be optimistic about in cancer care, with survival increasing and a wide range of research underway to keep those improvements coming. But it’s clear that the UK can, and should, do better when it comes to diagnosing and treating cancer.
In England, the independent cancer taskforce is examining how the country can best tackle the challenges that cancer will bring over the next five years, putting together a new ‘cancer strategy’ to improve survival.
Cancer strategies are a good thing. They set ambitious goals and provide resources across the health system to improve cancer outcomes. So we were really pleased by the announcement.
In our submission to the taskforce we put the case for diagnosing cancers earlier as a key part of what we believe should be in that strategy. We were therefore pleased to see these issues clearly mentioned in the Taskforce’s statement of intent at the end of March.
Diagnosing patients earlier will mean that more people survive their disease, and help narrow the international gap.
Improving the outlook for patients is at the heart of everything Cancer Research UK does. And by tackling the early diagnosis challenge on all fronts, we will beat cancer sooner.
Matthew Wickenden is Cancer Research UK’s Early Diagnosis Manager; Ifewumi Fagunwa is their Policy Development intern.