NHS 'must get better at early cancer diagnosis'

By Nick Triggle
Health reporter, BBC News

The NHS in England must get better at diagnosing cancers at an earlier stage if it is to continue to improve survival rates, the cancer tsar says.

Prof Mike Richards wants more focus on one-year survival rates, an indication cancer is spotted at a treatable stage.

His report found huge disparity, with lung cancer sufferers in Kensington and Chelsea three times more likely to live a year than those in Herefordshire.

To date, the health service has used figures based on five-year survival.

One-year survival - that is surviving a year after cancer is first spotted - is key in regard to measuring early diagnosis because death before the one-year mark is likely to be due to the disease only being identified at a late stage.

Surviving to the five-year mark also requires early detection but other factors such as access to drugs and surgery become important too.

The NHS is on the brink of hitting its 2010 goal of reducing deaths at the five-year mark by a fifth, based on figures from the mid-1990s.

There is no excuse for such a big difference between different areas Harpal Kumar Cancer Research UK

The recommendations by the cancer tsar were made in his second annual report following publication of the Cancer Reform Strategy in 2007.

The five-year plan promised an extra £370m to help improve care.

It has led to more screening, faster drug approval, extra training and more money for radiography equipment.

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His latest report, which has received the backing of Health Secretary Andy Burnham, revealed local survival rates for the first time.

Nearly all trusts failed to match the best rates elsewhere in Europe for the "big four" cancers - breast, colon, lung and prostate.

There was also a great deal of variation. For example, the one-year survival rate for lung cancer patients in Herefordshire was just 15.4%, compared to Kensington and Chelsea's rate of 43.7%. The national average of 28.1%.

'Best of Europe'

Professor Richards described the findings as "poor" and urged trusts to take action, saying it could save 10,000 lives a year.

"People living in most parts of this country are not getting diagnosed as early as they should.

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"As I have already highlighted, raising awareness and promoting early diagnosis are essential if we are to bring cancer survival rates up to the level of the best of Europe."

He told BBC Radio 4's Today programme it was unclear why England was struggling with early diagnosis, but GPs needed to "play safe" and refer more patients to hospitals.

He said the public's awareness of cancer symptoms was "pretty poor" and people needed to seek help earlier, but the diagnosis disparity was not a rich-poor divide.

"Class or affluence might be a factor - but it is only a factor, parts of the north of England, quite deprived areas, actually have good one-year survival rates, so it is not the whole story," he said.

ONE-YEAR CANCER SURVIVAL One-year survival is the best indication that cancer is being picked up at a treatable stage But data shows England is lagging behind the best of Europe on the big four - prostate, lung, colon and breast There is also a wide variation across the country, with death rates differing three-fold in some cases

Professor Steve Field, of the Royal College of GPs, agreed improvements were needed, but said doctors needed more support.

"Symptoms for some kinds of cancer are similar to those of many less serious illnesses, which makes it easier for patients and GPs to overlook their importance.

"What we would like to see is much faster access for GPs to diagnostic tests, an increase in the length of general practice training to give doctors more hands-on experience at the start of their careers and better information for the public on the symptoms of cancer."

Harpal Kumar, chief executive of Cancer Research UK, said the government had been bold in publishing the data.

But he added: "There is no excuse for such a big difference between different areas."

'Age discrimination'

Katherine Murphy, of the Patients Association, agreed GPs needed to improve, but also said that despite improvements, patients were still not getting "fast enough access to drugs and surgery".

Professor Richard's report comes on the same day an eight-month inquiry by MPs into cancer also concluded that early diagnosis was a problem.

The All-Party Parliamentary Group on Cancer accused the health service of ageism after highlighting the lack of access for people over the age of 75.

John Baron, chairman of the group, said: "We see a new universal one-year survival measure as a way of speeding up early diagnosis. This radical proposal will improve outcomes for all."

Early diagnosis has been made a priority elsewhere in the UK, although none of the countries have made one-year survival a focus like this.