Lancet Oncology has reported that a third of cancer patients in the UK are diagnosed in A&E where they present with acute symptoms associated with advanced disease and a poor prognosis. A comparison was made with A&E admissions in six other high-income countries and the UK patients fared the worst. In other words, we are failing to diagnose cancer early enough in the UK and many patients are dying unnecessarily.
The data was based on patients admitted to A&E between 2012 and 2017. For that reason, the authors warned that the pandemic has likely caused the situation to deteriorate further due to restricted patient access to their GPs and because hospitals were forced to give priority to Covid patients.
Sadly, it is well known that cancer survival in the UK lags behind other comparable countries. The most likely cause is a delay in diagnosis following onset of symptoms and this must be tackled. Better still, the diagnosis of cancer in asymptomatic patients must be improved by screening. Earlier diagnosis and treatment offers the only hope of improving survival. This can be achieved if Government, doctors and the public play their part.
First, it is essential that timely patient access to GPs is restored. Remote consultations may have a place but elderly patients especially are more likely to declare red-flag symptoms during a personal encounter which also offers greater diagnostic opportunities for the GP. Advancing age is the greatest single risk factor for developing cancer.
But patients must also take some personal responsibility for earlier diagnosis. The UK offers screening services for breast, cervix and bowel cancer but uptake hovers at 70-75 per cent for breast and only 55 per cent for bowel. The incidence of cervical cancer is rapidly on the decline as a result of efficient screening and vaccination of girls (and boys) before they become sexually active against the human papilloma virus. This has been a significant success story. The highly effective UK National Breast Cancer Screening Programme offers women aged 50-75 regular mammography which diagnoses cancer early and, in most patients, will avoid the need for a mastectomy.
Bowel cancer is the third most common cancer and the second most common cause of death from cancer. It is particularly amenable to screening because benign polyps are the precursor. Usually over five years, the polyps grow and become malignant. They bleed as they grow and blood can be identified in the stool by the FIT test (Faecal Immunochemical Test). Patients over 50 years of age are offered this test every two years and patients who do not participate may be doing themselves a huge disservice. Once bowel cancer spreads beyond the bowel wall, the prognosis plummets.
It is now well recognised that life-style choices contribute to as many as 40 per cent of cancers and heading the list of risks are obesity, smoking and excessive alcohol consumption. Obesity, an avoidable personal choice, is associated with breast, uterine (endometrial), prostate, kidney, bowel and oesophageal cancers. Smoking, as every packet warns, is responsible for lung, oesophageal, head and neck and bladder cancer. Alcohol is related to pancreatic and oesophageal cancer. Many of these behaviour patterns occur together, resulting in a significant and increasing burden to the NHS.
It would be a start if the importance of life-style induced cancers were stressed in schools. If children are old enough to be introduced to sexual education, they are old enough to know that smoking, alcohol and obesity can cause cancer.
Early cancer diagnosis is a public health emergency that can no longer be ignored. Tackling it will require proactive public education, improving GP services, rapid access to investigations, timely delivery of results and urgent referral to specialist care.
J Meirion Thomas is a consultant surgeon