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NAEDI – The Size of the Prize

by Ed Yong | Analysis

27 November 2008

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Professor Mike Richards

Professor Mike Richards

We’ve blogged a bit already about last Friday’s National Awareness and Early Diagnosis Initiative (NAEDI) conference. The Initiative aims to coordinate and support a vast amount of work to ensure that more cancers are diagnosed at an earlier stage when they can be treated more effectively.

These sentiments were echoed most clearly by Professor Mike Richards, the UK Government’s “cancer tsar”, who finished the conference with an inspiring talk entitled “The Size of the Prize”. In it, Richards clearly spelled out just how much the gathered delegates could hope to accomplish by working together.

He began by reiterating that Britain’s cancer survival rates trail behind much of Europe. If we matched the best of the Continent, we could have saved about 11,000 lives every year between 1995 and 1999, and about 8,000-10,000 lives per year between 2005 and 2009.

“That’s what we’ve got to shoot for”, he proclaimed. “Forget the average – that’s not good enough. We’ve got to aim for the being the best in Europe, as a relatively wealthy country with a national health service.”

Richards also concluded that the majority of these avoidable deaths (about 50 to 75 per cent of them) were due to people being diagnosed with cancer at an advanced stage, which makes it impossible to surgically remove their tumours.

Screening programmes or other treatments, such as chemotherapy or radiotherapy, can obviously affect someone’s chances of surviving cancer. But they aren’t practiced very differently in Britain compared to other European countries and there’s no evidence that our cancer patients receive significantly poorer treatments than those on the continent. Nor is it likely that the UK somehow has “peculiarly aggressive cancers” that are different from those in Europe at a biological level.

Richards felt that only the late stage at which UK patients are diagnosed could really account for the lower survival rates compared with the rest of Europe.

One-year survival rates are particularly telling. These are the odds that someone with cancer will still be alive a year after their diagnosis and they are a fairly good indicator of the stage at which cancer is diagnosed. Patients with advanced disease tend to have poorer short-term prognosis. And for “almost every type of cancer there is”, Britain is lagging behind the European average in terms of one-year survival rates.

All in all, we could potentially save an extra 4,000 to 7,500 lives every year – roughly the same number of people that are already saved through screening programmes – just through detecting cancers at an earlier stage.

So how to do it? Clearly, a lot of national work is needed and Richards particularly recommended:

  • summarising the existing scientific evidence on early diagnosis and its benefits
  • identify any gaps in the research that we need to plug
  • pilot new programmes aimed at encouraging earlier presentation and see which ones work.
  • look closely at diagnostic technologies, such as new blood tests, and see whether we use them differently to other countries.

Richards also saw the need for more local projects, and he issued a clear challenge to every Primary Care Trust or Cancer Network, asking them to look at their own one-year survival figures. “Unless these figures already match best in Europe, they should be doing something,” he challenged. “And remember that the best of Europe will have moved on from 10 years ago.”

Richards offered a final thought. “Action to promote early diagnosis could probably save 5000 lives per year, and we don’t have to wait for new discoveries or technological advances. Apart from actions to reducing smoking prevalence, what else provides us with such a good opportunity? Let’s do it.”