One person in two will get cancer during their lifetime according to the NHS website. Half of those getting a cancer diagnosis will live more than 10 years. The peak age for diagnosis is 85-89 but cancer can be diagnosed at any age.
The sooner the better
Most cancer diagnoses come as a surprise, even if strange and vague symptoms mean that the patient has thought about the possibility of cancer when a GP cannot immediately explain the symptoms.
Nearly 400,000 diagnoses are given each year in the UK and the sad fact is that a proportion of them come after a visit to A&E. Many of these cases are advanced at first diagnosis and some will be too advanced to treat. The majority of the 10+ year survivors were referred by GPs for investigation and treatment through the two-week wait system or after a visit to a consultant.
It is important to understand that early attention to symptoms offers a better outcome.
One challenge for society is recognising the influence of processed fast and fatty foods on the diagnosis of cancer. It takes a long time for changes such as the introduction of fast food to show an affect in population statistics, but a study recently published by researchers in Boston indicates that this connection, long suspected, may now be appearing.
Worldwide, there is a trend for younger people to be diagnosed with cancers which are known to be attributable to diet and lifestyle. The study findings are not conclusive but the trend they identify suggests a looming surge of epidemic proportions in cancer diagnoses among people under 55-60 years of age.
One of the key points the Boston researchers make is that raising awareness of this early-onset cancer epidemic and improving the early-life environment should be an immediate goal. Such actions are likely to reduce the burden of both early-onset and later-onset cancers, even if they would be opposed by the fast food industry.
So what do you do if you get a diagnosis?
Don’t panic. Don’t freeze. Don’t hide away. Don’t sell the family silver and dash away on that world cruise. It’s difficult to be rational and logical so it helps if you have a partner, close friend or relative, child or sibling, who can take the news more calmly, to talk to and offer rational support.
The key issue is to understand the diagnosis, any new tests and what the treatment plans are. You cannot be detached, another reason to have someone you trust involved to help.
You will have information from the clinician giving the diagnosis but it is only once you have got home that the questions start forming. You will have objectives which may conflict with one another. You want to be one of the 50% who survive but you don’t want any pain or drama along the way, and you want to protect those closest from what is happening to you, even though they want to help.
Getting all those questions answered can be challenging.
The good news is that informed advice is not difficult to get. If you cannot get the answers you need from your own doctors, there are many sources relevant for most, if not all the different kinds of cancer.
The national charities which focus on specific cancers, the rarer ones as well as the more common, have knowledge and expertise too, and they also draw on what patients are telling them. Some of them have helplines, usually staffed by experienced nurses, who will spend time with you quite willingly. Some also have support groups, email lists and Facebook pages offering contact with other patients but while such contacts can be valuable for morale, getting good quality information relevant for you may be more difficult.
Treatment should start within 60 days. For many patients it may be quicker but this target nationally is only being met in 60% of cases. The target is 85% starting treatment within 60 days from diagnosis but this was last met in 2015 so the decline in performance is long-standing. It pre-dates the pandemic, which has unquestionably made matters worse. Brexit too has had an effect, although it cannot be extracted from these data.
The NHS and cancer diagnosis
There have been some stark realities in the response of the NHS to cancer in the wake of both Brexit and the pandemic. The national data show that in the first year of the pandemic 45,000 fewer patients started cancer treatment. By November 2021 ‘urgent suspected referral’ numbers were higher than expected by over 6.8%, suggesting that people had been avoiding seeing their doctor with suspect symptoms until attention became urgent.
The NHS standard is that 75% of patients should know within 28 days of their referral whether they have cancer or not. This target is now consistently missed by quite substantial proportions. In November 2021, over one million people were waiting for diagnostic tests of all kinds, 20% of them waiting more than six weeks for scans, a figure 32% higher than in 2019.
Prior to 2010, it is known that 23% of all cancers were diagnosed as a result of a patient presenting at A&E. This had reduced to about 15% by 2016 through concerted action in primary and secondary care. If this number is rising once again through pandemic-related delay, targets for improving cancer survival will be missed.
The value of early diagnosis may be understood but the NHS’s ability to deliver it is very variable. The government’s move to allow GPs to directly access preliminary scans and other tests, taking a step out of the diagnostic process for many cancers, is an important one and gives some reassurance that promises about having cancer as a priority are being met.
Early diagnosis when a cancer is small and localised makes surgery easier. With many cancers, the risk of it then spreading is reduced and for many patients, surgery results in a cure. Delayed diagnosis makes initial surgery more complex, can result in the need for further treatment, and the risk of spread is much higher.
Cancer research is seeing earlier, more accurate diagnosis as a priority too.
Cancer Research UK is a partner with the National Cancer Institute (NCI) in the USA in the Grand Challenge programme. This funds academic and industry collaborations to address edge-of-science topics. One project, STORMing Cancer, is looking at whether certain cells could be used as an indicator of pre-cancerous conditions. First signs are promising but it could be ten years before such advanced ideas become a clinical reality.
An unacknowledged reality of Brexit is the loss of skilled people (many of them European) in the NHS. Nurses get publicity but radiologists don’t. Radiologists are the experts in analysing scans, an essential step in cancer diagnosis and treatment. Pathologists, medical physicists, interventional radiologists – a clinical unit may only need one or two people with these skills but if one of them leaves with no replacements available, the effectiveness of that unit, with maybe 30 other people involved, is significantly diminished.
No amount of political rhetoric about investing millions, raising training numbers, target setting to reduce backlogs, or building new hospitals, can address the absence of skilled people who could be recruited now if the quasi-religious dogma of Brexit was dumped.
Jeremy Hunt made vocal complaints about workforce planning when he was Chair of the Health Select Committee. Now, as chancellor, he finds himself limiting funding for that same ‘priority’. Nor will Brexit dogma allow him to back recruitment from Europe to fill the gap. The numbers of doctors in training in the UK will barely scratch the surface of the shortage. 12 years of failing to address staff planning and training will take decades to correct.
It is likely to become a reason for the government to allow further privatisation in the NHS. Cancer diagnostics would improve because radiology scans and pathology images can be easily shipped abroad electronically, allowing analysis by overseas experts working at home.
If this is the price of faster and better diagnosis, the government will argue that the loss of NHS skills makes the involvement of other providers essential.