Cancer survival in England has improved significantly, but earlier diagnosis remains key to saving more lives. 

Diagnosing cancer earlier can mean more treatment options and better outcomes. For cancers like bowel and lung, where late-stage diagnoses are common, thousands more people could survive their cancer for at least five years if they were diagnosed just one stage earlier. 

The Labour government published the first cancer strategy for England in 2000, and since then, our understanding of earlier diagnosis (ED) has evolved considerably. 

In the 2019 NHS Long Term Plan, NHS England set an ambition to diagnose 75% of cancers at stages 1 and 2 by 2028. This has helped to direct progress across the NHS in England, and we have seen huge efforts locally, regionally and nationally to roll out programmes such as targeted lung screening as a result.  

While the current government has pledged to reduce cancer deaths, and to move from ill health towards prevention, it hasn’t yet committed to a specific early diagnosis goal. Without clear ambitions and timeframes to focus strategy and guide action, we risk missing the opportunity to save lives. It is critical that an ambition is set in the upcoming National Cancer Plan. 

What is the best way to measure progress on earlier diagnosis?  

The NHS is under unprecedented pressure due to rising demand, workforce shortages and an ageing population with more complex health needs. That’s why national targets and ambitions must focus on what delivers the greatest impact.  

The current ambition to increase the proportion of cancers diagnosed at stage 1 or 2 has encouraged positive action on earlier diagnosis. However, it carries a risk: focussing solely on increasing detection of early-stage disease can lead to overdiagnosis – identifying more cancers that would not have caused harm in an individual’s lifetime. This could lead to patients having unnecessary investigations or treatments, and add pressure to the NHS without improving patient outcomes.

Following consultations with expert researchers and clinicians, we propose a new ambition, which focuses on reducing the rate of people diagnosed with later stage cancer (stages 3 & 4) by 2035.* This shift would prioritise detecting cancers that truly need treatment, helping avoid overdiagnosis while improving outcomes. 

Unlike current measures that focus only on people with cancer, our approach looks at the whole population. Changing the way we measure progress – from looking at the proportion of cancers diagnosed to measuring the rate of cancers diagnosed – will help us better reflect the impact of important work to prevent cancers as well as interventions to catch them earlier. This aligns closely with the 10 Year Health Plan shift from ill health to prevention.  

The ambition will also guide investment and support for research and innovation.  Unfortunately, we still don’t have accurate screening tests for many cancers, and we lack tools that aid GPs to assess cancer risk when a patient presents with symptoms. A renewed focus on reducing late-stage diagnoses, could accelerate the development of smarter, more targeted detection tools. 

No single ambition can capture every area where progress needs to be made. That’s why the National Cancer Plan should also include a wider set of indicators to ensure progress is made across all cancer types, including cancers that are not staged or are unstageable (such as blood and brain cancers). 

The Plan should also feature a commitment to reducing emergency cancer diagnoses. Too many people are still diagnosed after going to A&E or other urgent care settings – routes which are linked to worse experiences and outcomes, regardless of cancer stage. Instead, we need more cancers diagnosed through screening and GP referrals, which are associated with earlier detection and better patient outcomes. 

Are there challenges to changing the ambitions?  

There are implications to consider if these refined ambitions are introduced.  

Reducing the rate of people diagnosed with late stage cancer is a more complex metric than the previous ambition to diagnose 75% of cancers at stage 1 and 2. But NHS England has successfully used a complex metric to drive improvements in the past, such as the Summary Hospital Mortality Indicator. This has been central to quality improvement in secondary care for many years. 

Including late-stage and emergency presentation in the National Cancer Plan won’t mean that we lose lots of great work that has happened or is happening. Programmes such as supporting timely recognition and referral of suspected cancer, optimising screening and encouraging help-seeking with symptoms and signs will all still be important to meeting these refined earlier diagnosis ambitions.  

Instead, this approach will help the strategy focus on what really improves outcomes- supporting proven ways to diagnose cancer earlier and, most importantly, reduce the number of people dying from it. 

What next?  

By 2035, we could transform the prospects for people affected by cancer in England. The National Cancer Plan could be a turning point for cancer – but only if it strengthens the UK Government’s commitment to earlier diagnosis. Clear, focused ambitions will help galvanise and coordinate action to drive the most impact for people affected by cancer.  

But it’s not just about getting the ambition right – we also need to see implementation of interventions that we know work. For example, the government and NHS has promised a full rollout of lung screening by 2030 – we need this commitment to be restated in the cancer plan.  

And that’s not all. The cancer plan should commit to deliver annual targeted public campaigns to improve health knowledge, enable access to primary care and encourage positive behaviours like screening uptake – especially in underserved populations. It should also support GPs in referring patients for suspected cancer.  

Investing in research is crucial too – especially into areas where earlier diagnosis efforts have stalled. And we must harness proven technologies and innovations, such as AI in image reporting for screening and symptomatic pathways. 

To realise the government’s shift ‘from ill health to prevention’, policymakers must make earlier diagnosis a top priority, building on existing progress and committing to further action for the future.  

The opportunity to act is now – and the impact for people affected by cancer, and the NHS, would be significant.  

*Reduce the age-standardised incidence rate of late-stage diagnoses (stages 3 & 4) by X% by 2035.