This week has seen two high profile stories about cancer survival hit the headlines.
Both have, in their own way, highlighted what we and others have been saying for some time – that late diagnosis of cancer is a big, but ultimately solvable, problem.
This story came from an article written by Professor Mike Richards, the government’s Cancer Director, which is being published later this week in Cancer Research UK’s journal, the British Journal of Cancer.
Professor Richards looked at differences in survival rates between England and the rest of Europe for lung, bowel and breast cancer – the three most common types in this country.
Lots of things could explain these variations and Richards considered the impact of each one in turn, including differences in:
- delays before the cancers are diagnosed;
- screening services;
- access to treatments, and the quality of those treatments;
- the basic biology of these three cancers;
- other diseases or conditions that affect people with these cancers.
Based on this analysis, he estimated the ‘size of the prize’ at around 5,000 to 10,000 lives a year in England, which could be saved through a combination of earlier diagnosis and better access to surgical interventions.
The second story hit the headlines yesterday, and struck a similar chord. As reported in almost all the mainstream media, the Department of Health has published its second report on progress on its Cancer Reform Strategy.
The report contains a lot of good news – for example, on bowel screening, HPV vaccination, and the training of new surgeons and specialist teams. But on regional variations in cancer survival – the so-called ‘postcode lottery’ – it makes sobering reading.
But before we look at these problems, let’s just pause to consider the report’s significance.
Thanks to this report, for the first time ever, we have a clear picture of the discrepancies in cancer survival around England. Although we might not like what it says, this analysis is absolutely critical in helping improve cancer services, as it allows the NHS to target resources and advice to where it’s most needed – and also to identify the areas that are performing best, so that they can share their experience with others.
Indeed, the report’s very existence shows that the government is taking seriously the challenge of improving cancer services – and the lives of cancer patients.
It’s also worth pointing out that the survival analysis is a snapshot, and says nothing about how these figures have changed over the last few years. But we know from other studies that things are – slowly – improving.
One thing that’s especially welcome is the new focus on using one-year relative survival rates to measure and compare the effectiveness of cancer care.
“One-year relative survival” is calculated by comparing the percentage of cancer patients who are still alive one year after their diagnosis with the expected survival rate of a similar group of people in the general population.
This measure is used as an indicator of how early diagnosis and treatment affect cancer outcomes – and these rates are very sensitive to how advanced tumours are when they are diagnosed.
The report, which can be downloaded from the Department of Health website, highlights a number of uncomfortable truths:
- For bowel cancer, one year survival reached 80 per cent in Telford and Wrekin while the worst rates were seen in Waltham Forest, and Hastings and Rother (58 per cent).
- In lung cancer, Kensington & Chelsea had the best survival rate of 44 per cent and the worst was Herefordshire with 15 per cent.
- Breast cancer survival was 99 per cent in Torbay, and the worst was Tower Hamlets with one-year survival at 89 per cent.
So let’s also be absolutely clear. The fact that cancer survival is so variable across so much of England is unacceptable; especially given what we know about how early diagnosis can improve survival. Whether you survive cancer should not depend on where you are diagnosed and treated.
The government has made many promises about how it intends to improve peoples’ access to diagnostics, and to improve peoples’ awareness of the signs and symptoms of cancer. The launch of the National Awareness and Early Diagnosis Initiative (NAEDI) and its local counterpart (LAEDI) are significant steps in the right direction.
But ultimately we need government to make good its promises on diagnosing cancer early.
In addition, we’d also like to see:
- Primary care trusts, who can allocate funds within their budgets as they see fit, ensuring that they properly prioritise early cancer detection
- Well-coordinated, funded and targeted campaigns – nationally and locally – aimed at improving people’s awareness of cancer symptoms
- Renewed focus on ensuring all GPs and other front-line health professionals are fully up-to-speed with the latest evidence on cancer symptoms and diagnosis
- Proper flow of information from best-performing PCTs to those that are struggling
The 2007 Cancer Reform Strategy rightly put proper emphasis on early diagnosis. Despite today’s figures, things are improving, and this second report is an excellent and solid benchmark against which future progress can be measured.
But it’s not all about government policy and healthcare management. A key factor in all of this is that people often don’t seek help when they experience the signs and symptoms of cancer.
So have a read of our Spot Cancer Early web pages, watch our symptom awareness videos, and remember to see your GP if you notice anything unusual – it probably won’t turn out to be cancer, but it just might save your life.