Quick diagnosis is a vital way to win the cancer battle
ACANCER diagnosis is onerous enough now, but how much more grim it must have been back in 1948, the year the NHS was founded. At that time, radiotherapy was in its infancy and the cancerfighting properties of chemotherapy had only just been discovered in an American clinic.
There have been huge strides in cancer surgery and treatment in the intervening decades. What would have been a death sentence 70 years ago can now in many cases be commuted to an inconvenience.
Yet a disturbing reality is that Britain, the scene of so many medical breakthroughs, is trailing badly when it comes to treating the most common types of cancer. A paper just published in the journal Lancet Oncology reveals that while cancer survival rates have improved sharply in Britain over the past decades, they have improved by much more in other developed countries.
The study compared one and five-year cancer survival rates in Britain, Australia, Canada, Denmark, Ireland, New Zealand and Norway, and found that with many cancers we sit at the bottom of the table.
Take colon cancer. In the years 1995-99 47.0 per cent of UK patients were still alive five years after diagnosis. By 201014, that had climbed to 58.9 per cent. But still, British patients are dying faster than those in the other countries studied. In Australia, 70.8 per cent of patients were still alive five years after diagnosis.
IT IS a similar story with lung cancer. Since the late 1990s, the five-year survival rate has climbed from 7.2 per cent to 14.7 per cent. But it is still lower than in any of the other countries.Top of the table is Canada, with a survival rate of 21.7 per cent.
We are always being invited to praise the NHS – and in many senses we are right to do so. We were the first country to
introduce the principle of universal healthcare, regardless of means, and free at the point of delivery. Few of us would ever want to see that disappear.
Yet it is becoming ever harder to sustain Nye Bevan’s 1948 claim that the NHS would become “the envy of the world”. On cancer care, there is something wrong and our politicians need to recognise it.
There seems to be no one reason why our cancer survival rates lag behind other countries. According to John Butler, a consultant surgeon at the Royal Marsden Hospital and coauthor of the Lancet study, it is no use just looking at cancer care itself. There has been a radical improvement in surgery, with patients now more likely to be looked after by specialists rather than general surgeons.
A lot of the difference, he says, is down to the speed of diagnosis and first treatment. Other countries are more organised about screening for cancer, identifying symptoms and beginning treatment. The Government has set the NHS a target for hospitals to start treatment within 62 days of referral in 85 per cent of cases. Yet in 2018/19, 94 out of 131 cancer services failed to achieve this.
BUT the problems can begin at the first hurdle: getting an appointment with a GP. It is one thing to speed people suspected of having cancer through the diagnostic procedure, but what if you can’t get an appointment with your GP for three weeks?
True, surgeries might offer quicker appointments for emergencies, but in the mind of the patient that slight pain down the right side or the incident
when they bled from the rear end might not seem an emergency – especially given that many symptoms of cancer are far more likely to have benign causes.
If we want to improve cancer survival rates one country we should be looking at is Denmark – which among the countries in the Lancet study has improved most in recent years. It has done so thanks to its decision to make a huge investment in identifyng patients and targeting treatment at them. It is just such a radical approach we need in the UK.
In Britain we have a much more ad-hoc attitude to screening programmes than exists in many countries. We have mobile screening wagons in supermarket car parks for some cancers, such as breast and cervical cancer, but much less for others.
I wouldn’t want a health service where we are all monitored all the time and endlessly awaiting results in a constant state of anxiety. But still we need a more organised programme to identify people who have developed cancer and to speed them into treatment.
To do that, we need to accept that this is an area in which the NHS is doing much worse than it should be – and to look to other countries for inspiration.
‘Other countries are more organised about screening and treatment’