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Up to 10,000 people die needlessly of cancer every year because their condition is diagnosed too late, according to research by the government’s director of cancer services. The figure is twice the previous estimate for preventable deaths.
Earlier detection of symptoms could save between 5,000 and 10,000 lives in England a year, Prof Mike Richards will reveal this week. The higher figure is nearly twice his previous calculation, which put the figure at about 5,000.
Richards has revised up his estimate after studying the three deadliest forms of the disease ‑ lung, bowel and breast cancer ‑ which together kill almost 63,000 people a year.
“These delays in patients presenting with symptoms and cancer being diagnosed at a late stage inevitably cost lives. The situation is unacceptable,” Richards told the Guardian.
New efforts are planned to educate the public about the signs of cancer, tackle the widespread reluctance to tell their GP if they develop symptoms, and improve family doctors’ ability to spot signs of the disease earlier, he added.
Britain is poor by international standards at diagnosing cancer. Richards’s findings will add urgency to the NHS’s efforts to improve early diagnosis.
They also raise further questions about how often family doctors fail to recognise telltale signs.
Experts say early diagnosis can be the difference between a patient living for a short or long time or deciding whether they need surgery, such as a mastectomy, or not because quick access to surgery, drugs or radiotherapy greatly improves chances of survival.
In an article in the forthcoming British Journal of Cancer, which is published by Cancer Research UK, Richards will say: “Efforts now need to be directed at promoting early diagnosis for the very large number (over 90%) of cancer patients who are diagnosed as a result of their symptoms, rather than by screening.
“The National Awareness and Early Diagnosis Initiative [NAEDI] has been established to co-ordinate and drive efforts in this area. The size of the prize is large – potentially 5,000 to 10,000 deaths that occur within five years of diagnosis could be avoided every year.”
Richards reached his conclusions after analysing one-year survival rates for the three cancers in England and comparing them with those in other European countries in the late 1990s. Previously he had looked at the number of patients who were still alive five years after diagnosis.
One-year survival is now thought to be a much better indicator of whether diagnosis was early or late.
The study focused on Britain’s three biggest cancer killers: lung, which killed 34,589 people in 2007; colon (16,087); and breast (12,082). They account for 40% of the 155,484 cancer deaths in the UK in 2007 and, Richards found, about half of all the deaths that could have been avoided if diagnosis was as good as the best- performing European countries.
Richards found that “late diagnosis was almost certainly a major contributor to poor survival in England for all three cancers”, but also identified low rates of surgical intervention being received by cancer patients as another key reason for poor survival rates.
Research by academics at Durham University led by Prof Greg Rubin has identified five types of delay in NHS cancer care: “patient delay”, “doctor delay”, “delay in primary care [at GPs’ surgeries]”, “system delay” and “delay in secondary care [at hospitals]”.
The new initiative is intended to “fix this problem”, helping the UK’s 53,000 GPs improve their ability to identify patients who may have cancer, said Richards.
With smoking in decline “early diagnosis is our next big challenge in cancer and will be crucial in bringing our survival rates up to the best in Europe”, he added. Prof Steve Field, chairman of the Royal College of GPs, said: “Mike Richards’s latest findings on cancer diagnosis are really important information and reinforce the need for GPs to put a lot of effort into ensuring that patients present [their symptoms] and have access to GPs, and that we pick up the symptoms early on, and also reflect if we can do things even better in this crucial area of healthcare, which we can.
“It’s wrong to blame GPs for all these deaths, as there are many factors involved, including patients not recognising symptoms of cancer and not talking to their GP about them, especially middle-aged men. But I’m sure that we could all at times be more alert to symptoms and investigate and refer patients quicker,” he added.
Sara Hiom, director of health information at Cancer Research UK, said GPs faced a difficult task in spotting cancer: “Despite cancer being a common disease, the average GP will only see one case of each of the four biggest cancers each year.
“Many of the symptoms that could be cancer turn out to be something less serious, but it’s best to get things like unusual lumps, changes to moles, unusual bleeding or changes to bowel motions checked by a GP.”
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Early diagnosis usually means that treatment is more effective and milder for the patient, added Hiom.
Katherine Murphy, director of the Patients’ Association, said: “Some patients are diagnosed with cancer when they have presented with the same symptoms six months earlier.
“Patients will sometimes tell us that they had been going to see their GP for six to nine months with, say, a pain in their stomach and were told to go to the pharmacy and buy an over the counter medicine [and later are found to have cancer].”
http://www.guardian.co.uk/society/2009/nov/29/late-cancer-diagnosis-kills-thousands
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