Cancer algorithms herald the end of the GP
The genetics revolution can transform survival rates, but only if the system is radically overhauled
Tuesday this week was World Cancer Day. Not exactly a celebration, but an important reminder of a disease that now affects one in two of us. The last few days also saw the release of two outstanding scientific papers. The first reported the latest cancer survival figures across the globe. The second was the result of a decade-long project involving 1,300 researchers and 2,658 cancer patients. It found that tracking genetic errors through DNA could mean that cancers can be diagnosed and treated years before symptoms even appear. So what do these findings mean for us?
When it comes to cancer survival, Britain has done very badly over the last 20 years. Sure, cancer charities and politicians put on a brave face, claiming we’re improving every year. But so are others, and much faster.
The biggest differences between Britain and the rest are in cancers that are difficult to diagnose – such as pancreatic and ovarian cancers – because they have vague symptoms. Critics have blamed inadequate resources, poor GP training and the lack of treatment facilities. But the real reason is staring us in the face.
We know that although the five-year survival rate in the UK is poor, one-year survival is much worse. This can only mean that British patients are dying before they get effective curative treatment. Why? Because they can’t access the right treatment quickly enough. Getting to see a GP can take weeks, and may require several visits before a referral to hospital is made. Then there are further delays for scanning or biopsy – we still have fewer MRI and CT scanners per head than the rest of Europe. Even the British target – of 62 days to begin treatment – is laughable. In the US you’d sue if you had to wait that long.
But what if we could diagnose the cancer before it appeared? The Pan-cancer Analysis of Whole Genomes Consortium (the subject of the second of this week’s papers) has produced big data by any standards. Crucially, it found that only four to five key genetic mutations were identified in more than 90 per cent of all cancers. The timing of the mutations was identified using extremely clever technology. The big surprise was that the key changes took place years or even decades before the cancer actually caused symptoms.
This opens up the potential to identify “pre-patients”– a little like the “pre-cogs” in the film Minority Report, where criminal acts are predicted before they actually happen. Admittedly, in about 5 per cent of patients there were no early mutations – things just moved fast enough to give the cancer cells an advantage over their neighbours. But big data, massive computer power and sheer persistence can probably crack the multiple small changes that herald the onset of a killer cancer without the need for a human clinician to spot the early warning signs in a GP’S office.
Taken together, these papers have massive implications for the way we structure our healthcare system. Clearly, we have to do better with our diagnostic pathways. And if we can predict who is actually going to get cancer, we can target the right people with prevention messages, lifestyle changes and screening programmes. But we need the right system in place to do it. Healthcare is way behind consumer-focused industries such as travel and hospitality. They are the model for the future.
The nonsense of a GP referral letter belongs to the wonderful age when you knew your GP and he knew you. That doesn’t work when you can’t get an appointment in the first place. Not that clinics are any better in the private system: try phoning a busy oncologist’s hospital secretary – you are lucky if you can get through to the switchboard. Imagine trying to book a holiday like this.
The solution is to sidestep the delays. Create bright new early diagnostic centres in every town, away from busy hospital sites. Scans, biopsies and other tests can be carried out away from emergencies, and follow tried and tested algorithms. Bypassing the GP completely as the gatekeeper is the only way to improve our disastrous statistics. The genetic revolution is coming for cancer. It will save lives. But for it to work, we need to change how our healthcare system works in the first place.