Five reasons the UK must diagnose cancer earlier – and four ways to do it

The statistics in this blog post are averages based on large numbers of patients and can’t be applied to individuals. If you are looking for information on your own cancer, you may find our patient information useful.

Cancer survival in the UK has doubled in the last 40 years, and we can now treat the disease more effectively than ever before.

But diagnosing cancer early remains the most powerful way to give patients the best possible chance of surviving the disease.

Sadly, cancer can be a difficult disease to diagnose, and we still see many patients diagnosed in the later stages – where survival is often far lower.

So it’s unsurprising that ensuring more people are diagnosed early is an important part of the recently-announced Cancer Strategy for improving England’s cancer services over the next five years.

And this was reinforced once again today as our new figures on the potential impact of earlier diagnosis hit the headlines.

But the bold plans of the English cancer strategy can only be achieved if the NHS gets more investment. Many NHS services across the UK are already hugely stretched. If they don’t get more resources, opportunities to save more lives will be missed. And through research we urgently need to find new and better ways to diagnose the disease earlier.

So in case there was any doubt remaining, here are five very clear reasons that show why England and the UK as a whole must diagnose cancer earlier – and, most importantly, four ways we can do it.

Five reasons we must diagnose cancer earlier

1. People are more than three times more likely to survive if they’re diagnosed early

In our new analysis, published today, we’ve shown survival for some of the most common types of cancer is more than three times higher when the disease is diagnosed in its earlier stages.

Our analysis covers eight types of cancer where there’s high-quality, long-term survival data: namely bladder, bowel, breast, cervical, womb, malignant melanoma, ovarian and testicular cancers. Together, they account for more than 40 per cent of all cancer cases in the UK.

In the graphic below, you can see that – for these cancers – around eight in 10 patients (80 per cent) survive for at least 10 years when the disease is diagnosed at stage one or two – the earlier stages of the disease.

But this falls to around a quarter (25 per cent) in patients who are diagnosed at stage three or four.

And for those diagnosed at the earliest stage – stage one – survival is more than 90 per cent, compared with just five per cent for those who are diagnosed at stage four.

The only data available for this analysis came from the East of England, as particularly good data has been collected there for a number of years. But, it’s likely that we would see similar patterns for the UK as a whole.

The differences are stark and make it very easy to see just how much patients benefit if cancer is diagnosed early. But, across these cancers, more than a quarter of cases (27 per cent) are diagnosed at stages three and four. Finding ways to diagnose those cancers earlier will undoubtedly save thousands of lives.

2. Some cancers are much less likely to be diagnosed early

When considering data for all cancers (not just the eight included in the analysis above), we found that just over half of patients are diagnosed early.

But there are many types of cancer, and what this combined figure doesn’t tell us is just how much the likelihood of being diagnosed early varies between different cancers.

The graphic below shows the stage at which different cancers are diagnosed, and it’s clear that patients with cancers such as lung cancer and non-Hodgkin lymphoma (NHL) are much less likely to be diagnosed early.

These differences between cancers are caused by various factors ranging from how the disease develops; to how easy it is for patients and GPs to pick up on symptoms; and how effective the diagnostic tests available for them are.

Overcoming those issues is not a simple challenge, but as you can see below, there will be huge benefits for patients when we do.

3. It improves patients’ experience, not just survival

Improving survival is clearly an excellent reason for diagnosing patients earlier, but it’s not the only one. Across a whole range of measures, being diagnosed quickly and at an early stage improves patients’ overall experience of their care.

We recently published research showing that, if it takes more than three trips to the GP to be referred for cancer tests, patients are more likely to be dissatisfied with their overall care, eroding confidence in the doctors and nurses who go on to treat and monitor them.

But as well as research, talking to patients themselves also shows for some people just how much being diagnosed early can reduce the impact of a cancer diagnosis. In a recent guest blog post, John Marsh, who was diagnosed with stage one bowel cancer through the bowel cancer screening programme said that being diagnosed early meant, for him, cancer was “just an unpleasant episode”.

While it’s tempting to try to assign blame, it’s important to note that cancer can be very difficult to diagnose. Delays in diagnosis by GPs will usually be due to cancer symptoms being extremely hard to distinguish from other diseases, combined with a lack of accurate and easy-to-use tests that GPs can use. Those are difficult challenges to overcome – but the experience of patients like John shows why we must tackle them.

4. We want patients in the UK to have world-class cancer care

As the graphic below shows, survival in England is lagging behind the best performing countries in the world. Even in the most recent data for 2010-2012, England has not yet caught up with 2005-2009 survival figures for countries such as Sweden and Canada.

As we’ve discussed before, the UK as a whole is lagging behind the best performing countries, and that’s at least partly down to later diagnosis in the UK and fewer people getting the most effective treatments when they need them.

These comparisons across countries make it clear that earlier diagnosis and better outcomes are possible. But it needs investment in the NHS to ensure that patients receive world-class care. By making better use of the technologies and tests already available, thousands of lives could be saved.

5. All patients in this country should receive the best possible care

It’s not just internationally that we see differences in the stage at which patients are diagnosed.

The map below shows the proportion of patients  who are diagnosed early (stages 1 and 2) across the different local health care areas of England in 2013. Those areas are known as clinical commissioning groups (CCGs). You can look up how your own area is doing through our local cancer statistics website.

 

This unacceptable level of variation has been revealed because staging data is being collected far more effectively than just a few years ago.

There isn’t as much data available for Scotland, Wales and Northern Ireland, but it’s likely that there are similar inequalities across the whole UK.

The reasons for those differences will not just be down to the quality of local services. For example, we recently found that CCGs with higher levels of socio-economic deprivation tended to see fewer breast, bowel and prostate cancers diagnosed at an earlier stage. Socio-economic health inequalities are caused by a range of factors, besides the quality of local healthcare, something we’ve talked about before. For example, those from lower socio-economic groups can be less willing to see a GP to get symptoms checked out and to take part in the cancer screening programmes.

But we know that NHS services across the country can – and must – be improved.

So it’s clear there are big gains from diagnosing more cancers earlier, but how can it be done?

Four ways cancer can be diagnosed earlier

1. Encourage the public to get unusual or persistent changes checked out by a GP

We know that public awareness campaigns help to encourage people see their doctor if they notice unusual or persistent changes to their body. That’s important because research shows that people in the UK are more likely to worry about wasting the doctor’s time, than in some other countries.

The Be Clear on Cancer campaigns in England, which have been run for a number of different cancers, have had some very positive results. One of the campaigns focused on lung cancer symptoms and led to around 700 additional lung cancers being diagnosed – 400 of which were at an earlier stage.

Similar campaigns have been run in other parts of the UK, such as the Detect Cancer Early programme in Scotland.

Campaigns like these are a vital step in diagnosing cancer earlier, and governments across the UK must ensure they continue to support them.

2. Increase participation in cancer screening

Cancer screening saves lives, but for bowel screening in particular, the number of people taking part is disappointingly low. You can see bowel screening coverage in your area using our local cancer statistics website.

We – and many local teams – are working to promote the bowel screening programme so that more people have the information and support they need to decide whether they want to take part in screening, some of which we have written about recently.

Those responsible for local screening services also need to ensure they are focusing on reducing inequalities in screening uptake in their areas. Again, looking at the bowel screening programme, uptake is much lower in men, among those in lower socio-economic groups and who face issues like language barriers.

3. Invest in making the NHS a world leading health service

Cancer survival figures show the prize on offer if we can diagnose more cancers earlier. In England, if the Government acts on the recommendations in the new cancer strategy, we can increase the number of people diagnosed at an early stage across all cancer types from just over half of patients now to more than 60 per cent by 2020. This would improve the outlook for thousands of people with the disease.

Earlier diagnosis will only be achieved if the NHS can allow doctors more free freedom to get patients’ symptoms fully investigated. The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) have both recently updated their guidelines to help GPs refer patients with potential cancer symptoms – giving them more freedom to send for tests or to specialists. But to achieve this, the NHS will need to significantly increase access to diagnostic services investing more in both people and equipment.

All the countries of the UK must ensure that they prioritise investment in NHS diagnostic services.

4. Support research to develop  new and improved ways to diagnose cancer

As we have stressed, cancer can be a very difficult disease to diagnose. Sometimes symptoms are hard to distinguish from other diseases, and in some cases the disease doesn’t even cause any obvious symptoms.

In order to make progress in diagnosing cancer earlier we need better tests that can spot the disease more effectively and reliably while still in the early stages. The only way to develop those is through research. That’s why we are dedicated to supporting early diagnosis research that aims to give doctors the tools they need, and that aims to develop new screening tests for cancer.

Diagnosing cancer earlier saves lives

The case for diagnosing cancer earlier is clear. But to achieve this we must see the new cancer strategy for England implemented in full, including government support for the NHS. And with elections in the devolved nations next year, ensuring earlier diagnosis is a priority across the UK will be a key part of our calls to all parties.

Earlier diagnosis gives people the best chance of surviving cancer and a better experience of their care. We must now ensure it becomes a reality for more people through providing the world class services patients deserve.

Matt