Early cancer diagnosis could save lives

When I trained as a GP in the 1980s I often found myself in an uncomfortable position, working for a consultant who would not tell a patient that he or she had cancer, or have an open and honest conversation with them about their prognosis. They were often willing to lumber the patient’s relatives, partner or friends with the diagnosis instead. When I became an educator I resolved to do my part to change attitudes and improve the communication skills of health professionals.

There is huge potential to reduce unnecessary hospital use, emergency admissions and lengths of stay

I think part of the problem back then was we didn’t know enough about differentiation between cancers, we had few treatments that worked and, often, patients were referred too late. Today, talking about cancer is no longer taboo and, thanks to brilliant research and amazing clinical advances, we are likely to know more people living with cancer than dying from it.

But too many patients are still presenting with advanced disease and one year survival rates remain low.

It is estimated that up to 10,000 deaths could be avoided each year if survival rates matched the best in Europe. Promoting earlier diagnosis is the most important thing. As well as improving patient outcomes and life chances, it is also likely to be highly cost effective for the NHS.

What must change for us to be able to detect cancers at their earliest stages and make the improvements that will elevate the UK survival rate?

While many cancer symptoms are hard to detect, there is scope to improve early diagnosis in primary care and I hope GPs of the future will be able to estimate risk in cancer, as they can now in cardiovascular disease. Thanks to the fantastic research into risk assessment by Dr Willie Hamilton - an academic GP in Exeter - and his team, this day might not be far off. His work on ovarian cancer will, I believe, be seen as a major breakthrough in how we as doctors think about a condition that is potentially treatable.

Blame for late diagnosis is often wrongly laid at the door of GPs, so the introduction of the two week wait for urgent referral by the previous government was a major boost for patients and primary care clinicians. We all need to work together, so that patients understand when to go to the doctor, and GPs understand more about how clusters of symptoms can indicate serious conditions. This will lead to speedier referral to a specialist.

The Royal College of GPs is delighted all parties have supported speedier access to diagnostics, and we hope the coalition government will deliver on the commitment to allow GPs to directly refer patients for tests such as MRI and CT scans, and ultrasound.

Easier access

Giving us easier access is a superb idea. It would also help us to pick up on very early symptoms.

The RCGP model of federated general practice - with GPs sharing resources and expertise to deliver a wider range of services and improved care to patients in their community - could make a considerable difference in delivering this.

Dr Agnelo Fernandes and his Croydon Federation are ahead of the game. The diagnostics in the community programme has brought ultrasound, ECG and direct access MRI diagnostics into the participating GP surgeries and proved such a success that it was rolled out across the primary care trust.

Patients can have their test at six sites in Croydon; or in central London if more convenient. Patients are having their tests and receiving the results within two weeks on average.

Public awareness has a major role in early diagnosis and we must bring about a change in attitudes to our own health. We need to focus on prevention and changing the behaviours that cause cancers, the link between cigarettes and lung cancer being the most obvious. The work being done by our public health colleagues in Newcastle to reduce smoking is excellent.

We live in a celebrity dominated culture and we have seen the impact of Kylie Minogue’s breast cancer diagnosis and Jade Goody’s untimely death in increasing the number of women coming forward for breast checks and cervical smears.

But it would be preferable if we could achieve the same effect without something awful befalling a famous person. The attitude of GPs in promoting the benefits of screening for breast, cervix and bowel cancers and encouraging patients to have screening is crucial.

GPs would also welcome changes in secondary care. There is huge potential to reduce unnecessary hospital use, emergency admissions and lengths of stay.

There needs to be greater acknowledgement of the delicate balancing act GPs must strike in managing patient concerns around high suspicion of cancer while not “timewasting” by referring inappropriately to secondary care. By working in partnership with secondary care and our patients, I am convinced primary care can improve early diagnosis, both in the number of patients presenting relevant symptoms to GPs and those being referred appropriately for further investigation.

Our patients are depending on us to achieve this. The stakes are too high to get it wrong.