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GPs 'main driver' behind increase in early cancer diagnoses

More cancer patients in England are being diagnosed early and fewer are presenting for the first time as an emergency, according to new national statistics.

Experts praised general practice for the improved results, suggesting that it was 'very likely' that increased vigilance among GPs was a 'main driver'.

The National Cancer Registration and Analysis Service has released annual cancer outcome figures, which have seen the proportion of patients presenting as an early-stage case increase by seven percentage points between 2013 and 2016.

The newly published figures also show that the annual average proportion of cancer patients who first presented as an emergency in England has steadily decreased over the last five reported years, from 21% between July and September 2012 to 19% in the April to June period last year.

This emergency presentation metric looked at nearly all malignant cancers, excluding non-melanoma skin cancer.

NCRAS explained that this indicator is an ‘an important driver of cancer outcomes’, as patients that present as an emergency suffer ‘significantly worse outcomes’.

New figures for the stage of diagnosis were also released, showing the results between 2013 and 2016.

The metric highlighted that the one year average proportion of 10 cancers that presented at an early stage, defined as stage one or two, consistently increased from 46% between April and June 2013 to 53% over the same quarter in 2016.

The cancers included were invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary and uterus, non-Hodgkin lymphomas, and melanomas of skin.

University of Leeds primary care oncology Professor Ricard Neal said: ‘A shift to earlier stage diagnoses and fewer emergency presentations will save lives and improve quality of life. Whilst various factors will influence both of these trends, it is very likely that increased diagnostic activity in general practice is the main driver here'.

University of Edinburgh general practice Professor David Weller added that programmes such as Cancer Research UK’s National Awareness and Early Diagnosis Initiative have played their part, by providing strategies to 'help GPs and primary care teams diagnose, investigate and refer patients more quickly'.

He said: 'The response of GPs to these and other initiatives has been very encouraging; there’s a recognition that the UK’s cancer survival rates lag behind those of many comparable countries, and a determination to mobilise effort in primary care to improve our cancer outcomes. There’s more work to be done, but these and other data suggest we are heading in the right direction.'

BMA GP Committee clinical and prescribing policy lead Dr Andrew Green welcomed the news, calling the figures ‘encouraging’ and expressed the hope that they would be reflected in improved future survival figures.

He added: ‘Earlier diagnoses of prostate cancer through screening is perhaps most contentious, as earlier diagnoses can mean longer survival times without making any impact at all on mortality, and hence no benefit to the patient. Earlier diagnoses of malignant melanoma, on the other hand, will produce definite benefit.

‘The reasons for these changes are likely to be complex, but increased awareness among patients and high levels of vigilance from GPs are certainly likely.'

These figures come as NHS England announced 10 new 'one-stop shop' cancer diagnosis centres, which it claims will guarantee a diagnosis within two weeks of the patient's first appointment.

While these centres are currently being trialled, the scheme is set to be rolled out elsewhere in the country if successful.

Proportion of emergency presentations of cancer (1 year average)

2012-Q3 21.0%, Q4 21.0%

2013-Q1 20.8%, Q2 20.5%, Q3 20.4%, Q4 20.3%

2014-Q1 20.2%, Q2 20.2%, Q3 20.2%, Q4 20.1%

2015-Q1 20.1%, Q2 20.0%, Q3 19.9%, Q4 19.9%

2016-Q1 19.7%, Q2 19.8%, Q3 19.7%, Q4 19.5%

2017-Q1 19.4%, Q2 19.2%

Proportion of cancers diagnosed at early stage (1 year average)

2013-Q2 46%, Q3 47%, Q4 48%

2014-Q1 49%, Q2 50%, Q3 50%, Q4 51%

2015-Q1 51%, Q2 52%, Q3 52%, Q4 52%

2016-Q1 53%, Q2 53%, Q3 53%

Source: NCRAS

Readers' comments (8)

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  • The GPs are doing better lets sweat the assets some more, cut their funding and increase the red tape come the cry from the DoH.

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  • There was a cry to diagnose more cancers with scans, shortly afterwards the ultrasound department issued their own guidance stopping a lot of scans. Give us the resources and we will give you the results. No sunlight = no growth. Simple.

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  • told to refer less except 2ww, so anything suspicious went on 2ww. guess everyone else did the same. LOL. routine stuff - no chance. QED.

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  • Nhsfatcat

    GPs do ok at something well f-(£ me! Who knew?

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  • Vinci Ho

    The hypocrisy lies where GPs pushed themselves to refer more suspect cancer diagnoses in line with the latest NICE guidance (lower positive predictive value , the translation into increase in cancer survival (reduced mortality) is limited by long referral to first treatment time in secondary care . Do not forget when more cases of ‘false positives’ are referred , this creates more ‘demands’ in imaging , endoscopies etc . Question is :how much has been sacrificed for those ‘true positive’ (false negative as well ) cases in terms of reaching first cancer treatment on time ?

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  • With Vinici Ho on this one. On old NICE (5% positive predictive value and 10% conversion) my 2 man practice with average 24 cancers annually would have to refer 240 per annum ie 1 per working day

    Move to latest NICE at 3% positive predictive value and there is an inevitability of refer more and thus investigate more, with reduced conversion rate. Secondary care colleagues loving it!

    Locally struggle with 31/62 performance and improvement monies available are proportional to current level 31/62 performance. Sounds like a Catch 22 to me!

    Money available for vague symptoms (assume this means less than 3% PPV) but not so easily for FIT testing (NICE requirement) and Lung Screening like Manchester which would improve our locally dreadful lung cancer figures

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  • Vinci Ho

    Hence, the so called ‘we cannot solve the crisis in NHS by pumping in more money’ narrative is a slippery slope fallacy . On one hand , the narrative is about improving efficiency and reducing waste but on the other , you open the door for more ‘liberal’ screening . Then , unless you really are to pump in more money and resources into the system ,of course , this is not sustainable.
    The truth is , the traditional role of GP as the gatekeeper is being eroded ,undermined and vilified under this ridiculous physiology of the government. Thanks to the academics and NICE.

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