Earlier diagnosis

Last year (2021-2022), over 100,000 patients were diagnosed with cancer at stages one or two when it is easier to treat – the highest proportion on record.

Record numbers of people are getting checked for cancer – almost half a million more patients were checked between March 2021 and October 2022, compared to the same period before the pandemic.

Thanks to extensive NHS campaigns and early diagnosis drives, 546,890 more people were referred for cancer during this period – helping to recover the drop in people coming forward during the pandemic, when around 370,000 fewer people received checks.

This is really encouraging news and spurs us on as we seek to achieve the NHS’s ambition to diagnose 75% of cancers at stage I or II by 2028.

Cancer Alliances

Cancer Alliances are the driving force for change, providing dedicated focus and capacity to deliver improvements in cancer outcomes locally.

Early detection – new screening tests

Faecal Immunochemical Testing (FIT)

Comprehensive use of the Faecal Immunochemical Test (FIT) in patients with symptoms of bowel cancer is critical to improving bowel cancer survival in England, ensuring patients on the lower gastrointestinal urgent suspected cancer pathway can be diagnosed promptly and using our available colonoscopy capacity in the most effective way.

FIT should now be offered to all those presenting to primary care with symptoms of bowel cancer to help the GP assess whether a referral on the lower gastrointestinal urgent suspected cancer pathway is needed. This is supported by NICE guidance released in August 2023, and the British Society of Gastroenterology and the Association of Coloproctologists FIT guidance release in June 2022. NHS England also published two letters in support of this guidance which are linked below.

Use of FIT testing in primary care for those presenting with bowel cancer is part of the Network Contract DES Investment and Impact Fund, an incentive scheme focused on supporting Primary Care Networks (PCN) to deliver high quality care to their population. The document below shows performance for the FIT incentive at a National, Regional, ICB, Cancer Alliance, PCN and Practice level.

Investment and Impact Fund CAN02 FIT incentive

Percentage of lower gastrointestinal two week wait (fast track) cancer referrals accompanied by a FIT result, with the result recorded in the twenty-one days leading up to the referral.

Cancer workforce plan

NHS England works with Health Education England and other key partners to make sure that there is a workforce with the right skills and numbers to make sure cancer is diagnosed as early as possible.

From August 2016 to August 2022, there has been an increase of over 5,700 full time equivalent staff in cancer-related professions, including histopathologists, gastroenterologists, clinical radiologists, medical and clinical oncologists, diagnostic radiographers and therapeutic radiographers. In 2022/23, NHS England and Health Education England have invested a £81 million to develop and increase the cancer and diagnostics workforce.

Targeted lung health checks

Lung cancer is frequently diagnosed at a later stage than other cancers, due to there often being no signs at an early stage. The targeted lung health check programme (TLHC) offers lung health checks to participants aged 55 to 74 who are current or former smokers. The programme aims to improve earlier diagnosis of lung cancer, at a stage when it is much more treatable.

What happens at a lung health check?

  1. A nurse asks the participant questions about their breathing, lifestyle, family and medical history. Height and weight measurements are also recorded. Lung health checks are currently taking place virtually, due to the Coronavirus pandemic.
  2. Based on the answers provided by the participant, the participant may be invited for a low dose CT scan, which takes a detailed picture of the lungs. Participants who are not invited for a low dose CT scan will be discharged from the TLHC programme.
  3. If the results of the low dose CT scan show signs of anything concerning, the participant may be referred for further low dose CT scans and treatment.

The programme is currently established in 42 places, and has diagnosed more than 1500 cancers, 76% at stage 1 or 2. With some of the highest rates of mortality from lung cancer it is estimated that ~6,000 cancer will be diagnosed earlier than would otherwise have been.

Early diagnosis of liver cancer

Around 6,214 people are diagnosed with liver cancer each year. However, incidence of liver cancer has increased by 50% over the past decade and is expected to continue to rise. It is the fastest rising cause of cancer death in the UK and only 13% of people will survive five years or more after diagnosis. This is why early diagnosis is critical, however existing evidence suggests only 33% to 50% of liver cancers are currently diagnosed at an early stage (1 or 2).

To contribute to achieving the NHS Long Term Plan ambition to diagnose 75% of cancers at an early stage (1 or 2) by 2028, the Early Diagnosis of Liver Cancer Programme aims to:

  • Detect more hepatocellular carcinomas (HCC), which makes up 85% of all liver cancers, at an early stage, so patients can benefit from curative treatment.
  • Ensure more people at high risk of HCC are referred and continue to engage with liver surveillance pathways/programmes.

The programme includes 3 workstreams:

Improving liver surveillance programmes

National Institute for Health and Care Excellence guidance (NG50, CG165, CG115) recommends that people at high risk of liver cancer (those with hepatitis B and/or cirrhosis) receive 6-monthly liver surveillance. Liver surveillance is significantly associated with improved early-stage detections, curative treatment rates, and prolonged survival. There however remains variation in the quality of delivery of these services with patients not routinely being invited for surveillance or supported to attend those appointments.

Community liver health checks pilots

In partnership with the NHS Hepatitis C Elimination Programme and the operational delivery networks, fibroscans are being offered to the most underserved part of the community to identify people at risk of liver cancer and ensure they are enrolled in local surveillance programmes.

Primary care pilots

We are working with primary care 12 pilot sites to identify and test (fibroscan and blood tests) people at risk of liver cancer. Those identified with advanced fibrosis/cirrhosis will be enrolled in local surveillance programmes.

Network contract directed enhanced service (DES) – Early cancer diagnosis guidance

Early diagnosis is key to our survival efforts – it means an increased range of treatment options, improved long-term survival and improved quality of life. Across the NHS, there are a range of interventions designed to increase the proportion of cancers diagnosed early. Primary care has an important role to play in these cross-system efforts; working with secondary care to make the referrals process more seamless for suspected cancer and encouraging uptake of national cancer screening programmes will be key.

The NHS Long Term Plan commits to invest £4.5 billion of new funding to expand community multidisciplinary teams aligned with new primary care networks (PCNs) based on neighbouring GP practices that work together, typically covering between 30,000 and 50,000 people. Primary care professionals play a central role in helping to diagnose cancer early and supporting people as they live with and beyond cancer.

Early cancer diagnosis is one of three priority areas for PCNs from 2020/21 and the NHS Cancer programme has worked with a cross-sector working group to develop content for the Primary care network contract. The good practice guidance for the early cancer diagnosis service requirements includes advice for clinicians on safety-netting for PCNs and tools to implement robust safety netting protocols in EMIS and SystmOne.

Additional documents

Macmillan and Cancer Research UK have developed a range of COVID-19 related resources to support patients and healthcare professionals.

Implementing Lynch syndrome testing and surveillance pathways

This handbook sets out guidance to support local systems to implement Lynch syndrome pathways nationally for both colorectal and endometrial cancer. It is intended to be helpful and set out best practice, but of course will need to be adapted to local circumstances.

All cancer MDTs should also have a Lynch Champion in place to ensure all colorectal and endometrial tumours are tested for Lynch Syndrome