Cancer survival rates in England are higher than they have ever been and earlier diagnosis is a key part of improving survival rates further.
The NHS Long Term Plan continues to expand upon our work to transform cancer care so that from 2028, an extra 55,000 people each year will survive for five years or more following their cancer diagnosis and three in four cancers (75%) will be diagnosed at an early stage.
Earlier diagnosis is critical to meeting our survival ambition, as it means patients can receive treatment when there is a better chance of achieving a complete cure. Information on progress made on achieving early and faster diagnosis is provided below:
- Cancer Alliances
- Early detection – new screening tests
- Cancer workforce plan
- Targeted lung health checks
- Network contract directed enhanced service (DES) – Early cancer diagnosis guidance
- Implementing Lynch syndrome testing and surveillance pathways
Cancer Alliances are the driving force for change, providing dedicated focus and capacity to deliver improvements in cancer outcomes locally.
Faecal Immunochemical Testing (FIT)
Bowel cancer is the fourth most common cancer in the UK. If it is detected at an early stage, before symptoms even appear, it is easier to treat and there is a better chance of survival. NHS England has introduced a new bowel cancer screen test for determining risk of bowel cancer, the Faecal Immunochemical Test (FIT), which detects traces of human blood in stool samples. for over 4 million people that is easier to use than the previous test.
FIT is now used in the Bowel Cancer Screening Programme, where we expect it to We expect the new faecal immunochemical test for haemoglobin (FIT) to increase the take up of bowel cancer screening by around 7%. In trials using FIT we saw more men, people from ethnic minority backgrounds and people in more deprived areas take up the offer of screening for bowel cancer. With up to a third-of-a-million more people expected to self-administer the FIT test, it will increase the number of early-stage bowel cancers that are detected. There’s more information about bowel screening here.
In July 2022, the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain and Ireland (ACPGBI) published guidance recommending the use of FIT to triage patients presenting in primary and secondary care with signs or symptoms of suspected colorectal cancer. NHS England have published two letters to support the adoption of this guidance:
- System letter supporting the use of FIT in primary care
- System letter supporting the use of FIT in secondary care
The Cancer Workforce Plan has been jointly developed by NHS England, Health Education England and other key partners. It sets out a delivery plan to ensure the NHS in England has the right numbers of skilled staff to provide high quality care and services to cancer patients at each stage in their care.
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?
- 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.
- 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.
- 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 23 places with some of the highest rates of mortality from lung cancer and it is estimated that ~6,000 cancer will be diagnosed earlier than would otherwise have been.
- Targeted screening for lung cancer with low radiation dose computed tomography standard protocol and quality standards
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.
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.