How can we diagnose more cancers earlier?

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Cancer
Lung cancer CT scan

3,000 to 4,000 cancer deaths a year could be prevented by lung cancer CT screening programmes, beyond current lung health checks, writes Professor Charles Swanton. Lung cancer CT scan Credit: Wikimedia Commons/CC BY-SA 2.0

It’s an eye-opening statistic. 1 in 2 people in the UK will be diagnosed with some form of cancer during their lifetime.

Like many, we want to make a difference. Our ambition is to accelerate progress and see 3 in 4 people surviving the disease within the next 20 years

Key to this is diagnosing cancer at an early stage, when it’s more likely to be treated successfully, meaning a better chance of survival.

UK governments recognise the importance of diagnosing cancer at an early stage and there are various targets, plans and initiatives in place to work towards it. In England, the NHS have set bold ambitions for cancer, including that 3 in 4 cancers should be diagnosed at stage 1 or stage 2 by 2028, something we covered at the time.

But despite these ambitions and increased efforts in recent years, the proportion of cancers diagnosed at an early stage (1 and 2) has been stubbornly stable.

NHS England early diagnosis ambitions

Copy this link and share our graphic. Credit: Cancer Research UK

And with an ageing population, the total number of people being diagnosed with cancer each year will increase. This means that the government will need to increase diagnostic services just to maintain the current proportion of cancer patients diagnosed early.

To hit its ambition of 3 in 4 patients diagnosed early in England, the government will need an additional 100,000 patients to be diagnosed early each year from 2028. A monumental task that will require action on multiple fronts.

How do we get there, and beyond?

A lot has been done already to move the dial, including the launch of the National Awareness and Early Diagnosis Initiative (NAEDI) in 2008. NAEDI, which Cancer Research UK co-chaired with the then National Clinical Director for Cancer, Professor Sir Mike Richards, did a huge amount to grow and mobilise the early diagnosis community.

“The early diagnosis community has grown so much over the years, and there has been some excellent work done,” says Dr Jodie Moffat, head of strategic evidence and early diagnosis programme lead at Cancer Research UK.

“But there’s more we can be doing to ensure that we’re acting on all the things we know can make a difference now, preparing ourselves for what’s coming down the pipeline, and investing in the research that will identify the interventions of the future.”

To help, we’ve estimated the impact different types of activity could make to the stage distribution of cancer at an all-cancer level.

Graphic showing early diagnosis activity and its impact

Copy this link to share our graphic. Credit: Cancer Research UK

Key areas of activity include:

  • Implementing and improving life-saving cancer screening programmes.
  • Informing and empowering people to respond promptly to signs and symptoms that could be cancer.
  • Health professionals being alert to the risk of cancer and being supported to act, including access to tests and test reports, and pathways that suit the range of patients they see.
  • Research and innovation for the future, to fully realise the vision of bringing forward the day when all cancers are cured.

When it comes to assessing the impact different activity could have, estimates were based on existing data or informed judgement where data wasn’t available.

“For the screening related interventions it tends to be easier, because there is more evidence and data to go on,” says Moffat. “We look at how much impact a particular intervention has had on stage shift and work out what the impact would be of optimising that intervention.

“For example, we estimated what the impact on all cancer stage shift could be if FIT bowel screening was not only offered to everyone from age 50, but also if the cut-off point of what is considered to be a positive test result was reduced.”

“We must look forward”

Despite knowing what we need to do, there are challenges to overcome in the journey towards early diagnosis. “A challenge to achieving early diagnosis is that there is no one silver bullet,” says Moffat, whose team helped to create the ‘waterfall’ diagram. “We need to be making a number of changes and doing them well, quickly and equitably in order to deliver.

“This is going to mean investment in diagnostic equipment, it’s going to need workforce, it’s going to need cross-NHS and cross-community working. None of these things are easy, particularly at a time when there is a lot of pressure in the system of trying to recover from COVID-19. But we must continue to look forward and to bring about the changes needed to ensure everyone with cancer gets the best possible care.”

Undoubtedly, the COVID-19 pandemic has interrupted cancer services and the way in which people respond to and act on their health. Whether we will see the impact reflected in the cancer stage data remains to be seen, but sadly we wouldn’t be surprised if improvements in all-cancer stage 1 and 2 statistics continues to be slow, and for some cancer sites, if stage distribution gets worse.

“COVID-19 has undoubtedly brought challenges, but there is a lot to be positive about, and working together as a community to drive forward early diagnosis is one of those.”

Hope Walters is a strategic evidence officer at Cancer Research UK

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