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 – Be Clear on Cancer campaign
- Early detection – new screening tests
- Rapid Diagnostic Centres
- Faster Diagnosis Standard
- 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.
Be Clear on Cancer campaigns aim to improve early diagnosis of cancer by raising public awareness of signs and/ or symptoms of cancer, and to encourage people to see their GP without delay. The programme is led by Public Health England, working in partnership with the Department of Health and NHS England.
The National Cancer Registry and Analysis Service evaluate the campaigns and the results of previous campaigns.
Bowel cancer screening
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 over 4 million people that is easier to use than the previous test.
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. For more information bowel screening, please visit the screening page.
Rapid Diagnostic Centres (RDCs) are designed to speed up cancer diagnosis and support our ambitions to achieve earlier diagnosis, with improved patient experience, for all patients with cancer symptoms or suspicious results.
The Long Term Plan commits to the roll-out of new RDCs that bring together modernised kit, expertise and cutting edge innovation, building on 10 models piloted with Cancer Research UK and Macmillan. These centres will begin by focussing on diagnosing patients with non-specific symptoms and who may go to their GP many times before being sent for tests.
We are setting an ambitious five-year vision for RDCs. In time, they will offer a single point of access for all patients with suspected cancer. They will offer a personal, accurate and fast diagnosis service, with excellent patient experience.
A national evaluation will be conducted to further understand the impact of RDCs on patient outcomes and inform national policy development.
7 key components of an RDC
Rapid diagnostic centres include the following components
- Early identification
- Timely referral
- Symptom assessment
- Coordinated testing
- Timely diagnosis
- Onward referral
- Patients will receive excellent coordination and support throughout this process.
The new Faster Diagnosis Standard will ensure that all patients who are referred for the investigation of suspected cancer find out, within 28 days, if they do or do not have a cancer diagnosis. This standard will be introduced in April 2020.
Hospitals are recording data in 2019, which will help us to understand current performance in England. It will enable Cancer Alliances to identify where improvements need to be made before the standard is introduced.
This new standard should help to:
- Reduce anxiety for patients who will be diagnosed with cancer or receive an ‘all clear’ but do not currently hear this information in a timely manner;
- Speed up time from referral to diagnosis, particularly where faster diagnosis is proven to improve clinical outcomes; and
- Reduce unwarranted variation in England by understanding how long it is taking patients to receive a diagnosis or ‘all clear’ for cancer across the country.
To prepare for the Faster Diagnosis Standard, NHS England introduced a new Cancer Waiting Times System in April 2018. The system now collects data for the Faster Diagnosis Standard, in addition to other cancer access standards, on a monthly basis. Cancer Waiting Times Guidance (v10) was published in April 2019 to explain how providers should record data in the new system, using the updated dataset (v2.0).
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.