“I am so lucky; they caught the cancer early.” These are words many of us can associate with – we all know people who’ve been affected by cancer, and we all know that catching it early is a huge factor in survival. All too often, the crucial word in that sentence is “lucky”. The question is how can we use new technology and tests to take the luck out of it?
That’s what the NHS-Galleri trial seeks to achieve – and today is a moment of celebration as that trial has, in 10 months, surpassed its target for recruiting 140,000 participants.
Some cancers are relatively easy to diagnose early, particularly those with obvious symptoms such as a lump or a suspicious mole. Look at cancer diagnosis staging data and you’ll find over 8 in 10 breast cancers and almost 9 in 10 melanomas are found at stages 1 or 2, when they’re still localised and easier to treat. But many other cancers during their early stages either display no discernible symptoms at all or come with symptoms that are very mild or could easily be dismissed as being other common ailments.
Fewer than 1 in 4 cancers in the pancreas or oesophagus, for example, are currently found before they’ve spread either to lymph nodes or to other parts of the body.
Our NHS Long Term Plan boldly sets out an ambition for us to diagnose three quarters of all cancers early by 2028, up from around 55% now. While we’ve been making steady progress on this in recent decades, and cancer survival has improved markedly thanks to advances in treatment, we will need a significant acceleration in our progress to meet that ambition.
The Galleri blood test developed by Grail harnesses the latest advances in genomics – it involves a single blood draw which is analysed to look for tiny changes in the DNA which ‘signal’ potential cancers. Not only can it indicate whether someone might have cancer – it has the precision to say which part of the body the cancer is likely to be in. It can identify over 50 types of cancer, often at an early stage before symptoms appear.
The NHS-Galleri trial, a partnership between NHS England, the Digi-trials unit at NHS Digital, Grail, and The Cancer Research / King’s College London Cancer Prevention Trial Unit, is assessing whether this technology could be used as a new screening test for cancer. The trial is an example of the new-found faster innovative approach and confidence the NHS has recently evolved, delivered with the same mindset the NHS has utilised to tackle the pandemic.
It has recruited over 140,000 participants aged between 50 and 77 who have no cancer symptoms and who haven’t had cancer for at least the last three years (if ever), across 8 different parts of the country – half of them in the trial arm, the other half in the control arm. Each will provide a blood sample each year for three years. The trial is looking at how effective the test is at diagnosing cancers in this asymptomatic cohort (i.e.dc as a screening tool), and whether it’s making a difference in the stage at which those cancers are diagnosed.
It has been a monumental undertaking with participants having blood taken in mobile units at over 150 convenient community locations, with partnerships set up in weeks and months that would previously often have taken years for a trial of this scale.
It is too early yet to draw conclusions from the trial, but if the initial results are promising, the NHS is committed to buying 1 million tests for use in 2024 and 2025. The NHS Cancer Programme is already planning for that roll out.
I’m proud of the role I’ve played as the clinical advisor for the programme, but it is only thanks to the dedicated work of the NHS nurses, project and research managers, phlebotomists and doctors that we have been able to make such swift progress. Our colleagues across the 8 Cancer Alliances taking part – Northern, East Midlands, West Midlands, South-East London, Kent and Medway, Cheshire and Merseyside and Greater Manchester and East of England – deserve special mention.
Thank you too to all the trusts supporting the trial. Any patient in whom the test detects a ‘signal’ is being referred onto the relevant two-week-wait suspected cancer pathway, meaning our NHS clinicians are some of the first in the world to see asymptomatic people in their clinics because of a Galleri test result. We appreciate the enthusiasm you’ve shown to seeing Galleri trial patients alongside the many other people currently on cancer referral pathways; thank you for understanding the potential of the test and what it could mean for our ability to diagnose cancers earlier.
And of course, we must say a big thank you to the 140,000+ participants – you are all playing your part in what could prove to be an historic trial. Your work is not yet done – we need you come back in years 2 and 3 to provide your second and third samples, as I’m sure you will, but thank you for being part of it.
In future, it will be less about ‘luck’ whether cancers are diagnosed early. Utilising new technologies and tests, we hope cancer survival figures will not just continue to improve but be one day significantly transformed.