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)

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:

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.

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