Opinion: ‘The UK must be more ambitious than just clearing the cancer backlog’

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

Comment and opinion from Cancer Research UK’s community of experts. The opinions outlined in this article do not necessarily represent the views of Cancer Research UK.

Despite staff working flat out, the pandemic has been devastating for NHS cancer services.

Cancer Research UK estimates that 3 million fewer people were screened for cancer between March and September last year, meaning around 9,200 fewer patients started cancer treatment as a result in England alone – a 42% drop.

And the charity’s latest analysis suggests that around 45,000 fewer people were diagnosed with cancer than expected last year – people undiagnosed in the community but not yet in the system.

Of course, NHS staff have been working tirelessly to protect and reconfigure cancer services, and figures from March reveal that more people are now being seen than ever before. Nevertheless, a substantial cancer backlog remains that must be urgently cleared.

But just clearing this backlog isn’t enough. Achieving Cancer Research UK’s vision of 3 in 4 people surviving their cancer by 2034 will mean going further: boosting cancer services beyond pre-pandemic levels, and renewing national research capacity and infrastructure.

It will also mean ‘levelling up, ’ addressing long-standing, unacceptable, cancer inequalities across the UK, which equate to around 20,000 more cancer cases each year.

For diseases like lung cancer, which disproportionally affects more deprived groups, “levelling up” means greater investment in smoking cessation services, and in CT imaging of high-risk individuals with smoking histories. 3,000 to 4,000 cancer deaths a year could be prevented by lung cancer CT screening programmes, beyond current lung health checks.

When it comes to diagnosing other cancers, this means easier and rapid access to diagnostic tests and investigations. Health services already have a roadmap for this, with the recent Independent Review of Diagnostic Services, chaired by Sir Mike Richards, leading to roll-out of rapid diagnostic centres.

We also have to focus on ensuring equality of care across the country. In my speciality, the proportion of early-stage lung cancer patients having surgery to remove their tumour varies hugely across England. If patients aren’t receiving surgery that we know saves lives, something must change.

This will require substantial investment in staff and diagnostic equipment. The UK went into the pandemic with fewer specialists and fewer scanners than most comparable countries.

Since then, data from the Rapid Cancer Registration dataset collected between April and September 2020 shows that fewer people were diagnosed with lung cancer last year than expected. I worry that this will lead to more people presenting with later stage, harder to treat disease.

In addition to these disruptions, cancer clinical trials were put on hold for the best part of a year and drug development slowed. This, in turn, will have slowed down future improvements in cancer care, which depend on the research and clinical trials of today.

In the last decade we’ve seen huge breakthroughs, for example in cancer immunotherapy, now a real hope for people with late as well as early stage cancers. We need to develop the next big ‘immunotherapies’ of tomorrow. Such breakthroughs require investment today in discovery “blue skies” science.

Take osimertinib – an extremely effective lung cancer drug, recently approved by NHS England to prevent recurrence after surgery, in patients whose tumours contain a defective copy of a gene called EGFR.

This gene was first associated with cancer in the 80s by Cancer Research UK scientists studying the links between viruses and cancer. The drugs developed off the back of this have transformed survival rates for certain forms of lung cancer.

We need the Government to invest in the country’s discovery science infrastructure and ensure a conveyor-belt of new scientific discoveries to help patients of tomorrow.

Getting to the next level

We went into COVID-19 with cancer services that needed improvement. We’re coming out with a long waiting list and many people in our communities with undiagnosed cancers. And we’re almost a year behind on life-saving cancer research.

Now is the time to build something better. It will require investment on multiple levels – workforce, equipment, primary care, diagnostic centres and the clinical research scientists who will help deliver the medical breakthroughs our patients so desperately need. And investment in our great tradition of world-renowned biomedical research, which gave the world scientists like Godfrey Hounsfield, Rosalind Franklin, Ernst Chain and Dorothy Hodgkin, and, consequently, a mastery of cancer imaging, DNA structure, penicillin and protein structures that have resulted in immeasurable benefit for patients.

With the right approach, we can emerge from this pandemic with better, world-leading, cancer outcomes. A cancer pathway that is more innovative, flexible and better equipped. All within a health system and a world-leading clinical research infrastructure that continuously strives to improve outcomes, providing patients and future generations with their best chance of survival.

About the author

Professor Charles Swanton, Cancer Research UK’s chief clinician.

Professor Charles Swanton was appointed Chief Clinician for Cancer Research UK in October 2017. He has responsibility for the strategy and shape of the Charity’s clinical activities, both in clinical research and in the wider context of cancer prevention, diagnosis and treatment.

Swanton completed his MDPhD in 1999 at the Imperial Cancer Research Fund Laboratories and Cancer Research UK clinician/scientist medical oncology training in 2008. He combines his laboratory research at the Francis Crick Institute with clinical duties at UCLH and as director of the CRUK Lung Cancer Centre, focussed on how tumours evolve over space and time. Charles has helped to define the branched evolutionary histories of solid tumours, processes that drive cancer cell-to-cell variation in the form of new cancer mutations or chromosomal instabilities, and the impact of such cancer diversity on effective immune surveillance and clinical outcome.

Charles was made Fellow of the Royal College of Physicians in April 2011, appointed Fellow of the Academy of Medical Sciences in 2015, Napier Professor in Cancer by the Royal Society in 2016, appointed Cancer Research UK’s Chief Clinician in 2017, and elected Fellow of the Royal Society in 2018.