Finding cancer early can make a real difference because early diagnosis can make treatment simpler and more likely to be effective. Both NHS Wales and NHS England have been developing different strategies for quickly diagnosing cancer.
In 2012, the Welsh Government published its Cancer Delivery Plan for NHS Wales up to 2016. This Plan sets out the Welsh Government’s commitment to maintaining and reviewing screening programmes, and to promoting screening uptake among ‘those less likely to take up screening’. On early diagnosis, the Plan emphasises developing oncology services ‘to support the diagnostic process in patients admitted as emergencies’, and of raising awareness ‘among public and health professionals about the risks and symptoms of cancer and how to act promptly and appropriately on this knowledge’.
… offering patients the option to self-refer for diagnostic tests; lowering referral thresholds for GPs; and multi-disciplinary diagnostic centres where patients can have several tests in the same place on the same day.
In Wales, the Assembly’s Health and Social Care Committee recently carried out an inquiry into the Welsh Government’s implementation of the Cancer Delivery Plan. In its recommendations to the Minister, the Committee underlined the importance of:
- Working to address social inequalities in the uptake of cancer screening;
- Continuing to raise awareness among GPs of early cancer symptoms to improve early diagnosis;
- Continuing to develop tools that may support GPs detect cancer early; and
- Working to ensure GPs are clear about the services available.
The Welsh Government has accepted the recommendations of the Committee on the screening and early diagnosis of cancer.
The Welsh Government develops policy on cancer through its Cancer Implementation Group, which receives advice from the Cancer National Specialist Advisory Group. Two cancer networks, the South Wales Cancer Network, and the North Wales Cancer Network, work with providers to co-ordinate the planning and delivery of cancer services.
- Cervical screening aims to prevent invasive cancers from developing;
- Breast cancer screening tries to diagnose cancer early to reduce mortality rates; and
- Bowel cancer screening combines early diagnosis with removing small growths which helps to prevent cancerous growths.
The following table shows cancer uptake/coverage rates across the UK. These comparisons are not exact, as indicators may be collected differently or relate to different time periods:
Cancer screening uptake/coverage rates in the UK
|Bowel Screening Uptake (aged 60-74, tested within 2 years)Target: 60%||52.6%(2013-14)||58.5%(2012-13)||56.1%(2011-2013)||47%2|
|Breast Screening Uptake (aged 50-70, tested within 3 years)Minimum Standard 70%Target 80%||72.1%(2013-14)||76.4%(March 2013)||73.5%(2010-13)||72.3%
|Cervical Screening coverage (aged 25-64, tested within 5 years)Target 80%||78.4%(2014)||78.3%(March 2013)||70.7%1(March 2014)||78.0%
1 In Scotland, cervical screening is offered to eligible women aged 20-60 every three years. This figure shows the proportion of eligible women screened in the previous 3.5 years.
2 In Northern Ireland, the Ministerial target for Bowel Cancer screening coverage is 55%
The Health and Social Care Committee’s inquiry raised concerns with the impact of social inequality on screening uptake. Public Health Wales’s screening division outlines the connection between social deprivation and screening coverage. Using their data, the table below compares the most deprived 20% with the least deprived 20%:
The main difficulty is that those in more deprived social groups are also more likely to develop cancer. To tackle these inequalities, Public Health Wales has set up a Screening Engagement Team and launched a national campaign, to be run in July of each year, aimed at raising awareness of the importance of screening.
According to research by the National Cancer Intelligence Network (NCIN), nearly a quarter (24%) of all cancers are diagnosed through emergency presentation, rising to almost a third (31%) of people who are over 70 years of age.
To increase the rate at which cancers are diagnosed quickly, NHS Wales has been developing a number of programmes.
First, Macmillan have been working with Aneurin Bevan University Health Board to pilot schemes that heighten GPs’ awareness of the signs and symptoms of cancer. Following the success of one such scheme, GP Facilitator posts are to be rolled out across Wales.
Second, NHS Wales has been developing a ‘Primary Care Oncology’ programme. This is a framework that ‘will act as a guide for GPs, health boards and Welsh Government by setting out tools, processes and information on how primary care manage and support people affected by cancer’. As part of this work, the programme will ‘develop work streams to enhance the first point of contact with symptoms and earlier diagnosis’.
Third, NHS Wales has been improving the recording of cancer to better identify the stage of the cancer when it is first diagnosed. As a result, head and neck cancer, upper gastrointestinal cancer, and lung cancer have been identified as cancers that are diagnosed at an advanced stage (stage 3 or 4). The Welsh Government has set out to understand care pathways and opportunities for service improvement in relation to newly diagnosed lung and digestive cancers.
Article by Shane Doheny, National Assembly for Wales Research Service.