Early cancer diagnosis aim ‘seriously off target’, report warns

The ambition to diagnose cancer in its earliest stages in England is “seriously off target”, according to a new report.

A rise in urgent referrals in recent years has contributed to delays, along with patients finding it difficult to raise concerns about cancer with GPs.

Inequalities in diagnosis, particularly among young people, those in deprived areas, and patients from ethnic minorities, was also highlighted by researchers.

Experts said that while family doctors are “highly trained” to identify cancers, the issue remains a challenge in primary care because some symptoms can be vague.

The NHS Long Term Plan said the health service is aiming to diagnose 75% of cancer patients when the disease is in its early stages by 2028.

However, analysis of NHS data by QualityWatch, a research programme by the Nuffield Trust and The Health Foundation, said “our current course shows we are seriously off target”.

More than 320,000 people in England were diagnosed with cancer in 2021 – the equivalent of some 900 a day – the report said, with the number of urgent cancer referrals rising since 2009 to more than two million in 2020/21.

However, two in five diagnoses are taking place once the disease has already advanced to late stage, the analysis claimed.

Dr Liz Fisher, senior fellow at the Nuffield Trust, said: “Delays to a cancer diagnosis pose real risks for people and an early diagnosis plays a pivotal role in determining the treatments available to people and determining outcomes.

“Detecting cancer early is vital to improving survival rates; for example, the rate of survival for bowel cancer drops significantly from 80% if caught in stage 2 to 11% at stage four.

“The NHS has set an ambitious goal to dramatically increase early detection of cancer, but performance in this area has stubbornly stalled in recent years.”

The research found one in five people is having three or more conversations with GP staff before they are diagnosed with cancer.

This rises to one in three among people from mixed, Asian or black ethnicities.

The issue is also common in younger people, the report said, with almost half of 16 to 24-year-olds having three or more appointments, while one in five had five or more.

The analysis also found that people from deprived areas are 21% less likely to be referred for tests or to see a specialist.

Dr Fisher added: “Everyone’s experience of cancer diagnosis is different but the risks to delays aren’t felt equally, with younger people and those from minority ethnic groups requiring more visits to health professionals to secure a diagnosis.

“Screening programmes have helped for some cancers, but more needs to be done to target support to specific groups given demand on cancer services is only set to grow.”

Figures published earlier this month revealed NHS England has met one of its cancer diagnosis targets for the first time.

Of the 253,025 urgent cancer referrals made by GPs in February, some 78.1% were diagnosed or had the disease ruled out within 28 days, up sharply from 70.9% in January and above the 75% target.

However, the proportion of patients facing long waits for treatment remained well below the 85% target.

Some 63.9% waited longer than 62 days from an urgent suspected cancer referral or consultant upgrade to their first definitive treatment for the disease in February, up from 62.3% in January.

Tim Gardner, assistant director of policy at The Health Foundation, said: “For cancer, quick diagnosis and treatment saves lives. Recent progress on the rate of people receiving a cancer diagnosis within 28 days of a referral is very welcome.

“However, this analysis highlights the need to improve people’s access to primary care, especially in more deprived areas, so that more people can be diagnosed earlier.

“This ultimately depends on boosting primary care capacity through sustainable, long-term investment and growing and supporting the workforce.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: ”Ensuring patients receive timely and appropriate referrals for suspected cancers is a priority for GPs – and to this end, they are doing a good job, making more urgent referrals and ensuring more cancers are being diagnosed at an early stage than ever.

“Whilst GPs are highly-trained to identify cancers, this remains challenging in primary care, not least and particularly with some cancers, because the symptoms are often vague and typical of other, more common conditions.

“This will particularly be the case in young people, as the risk of cancer will be much smaller, which goes some way to explaining this element of this research. But it also makes clear that health inequalities, and the impact of them, extend to cancer diagnosis – and this must be addressed.”

The QualityWatch report said screening is the most effective way to detect cancer early.

Some 88% of cases were picked up at stages one or two of the disease compared with 61% when going through general practice and 32% through A&E.

However, it warned that screening can sometimes “cause harm”, including over-diagnosis, which can put further pressure on health services.

An NHS spokesman said: “NHS staff are working hard to ensure that everyone affected by cancer receives a prompt diagnosis, regardless of their age, ethnicity or socioeconomic status.

“The NHS is diagnosing more people than ever for cancers at an early stage and, for the first time, over three million people were referred by GPs for potentially lifesaving cancer checks last year.

“Amid record demand in February 2024, the NHS also exceeded the Faster Diagnosis Standard target for cancer, with 78% of people diagnosed within 28 days of their GP’s referral.

“It is vital that people come forward if they are concerned about cancer symptoms – getting checked saves lives.”

A Department of Health and Social Care spokesperson said: “The NHS has seen and treated record numbers of cancer patients over the past two years, and survival rates are improving across almost all types of cancer, but we know there is more work to be done.

“We have invested £2.3 billion into Community Diagnostic Centres across England which are speeding up diagnoses for cancer, with checks and scans being delivered at 160 sites across England, helping us achieve our goal of catching 75% of all cancers at stage 1 or 2 by 2028. Cancer is also one of six major conditions included in our upcoming Major Conditions Strategy.”