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The tsar who rebranded cancer

The Government's national cancer director on the shift in emphasis on the disease and the vital role of GPs

By Lilian Anekwe

The Government's national cancer director on the shift in emphasis on the disease and the vital role of GPs

It's an important time for the Government's cancer tsar, Professor Mike Richards.

With the looming smoking ban and the publication of the new 'reform strategy' later this year, cancer is in line for a bit of a rebrand. From something we couldn't do anything about, to something both the public and primary care can take active measures to tackle.

The House of Commons, easily visible across the Thames from his office, is a constant reminder for Professor Richards of the tension between his two roles. For as well as being the Government's national cancer director, he works within the NHS as a professor of palliative care at St Thomas' Hospital in London.

Despite his lofty role and enviable geographical location, Professor Richards is quick to point out he is in touch with life on the ground. His brother is a practising GP so he is, he says, 'familiar with Pulse, and well versed in GP issues'.'Cancer has changed a huge amount since I started as tsar,' he says. 'Ten years ago cancer was in a really poor state in this country. What we have done over the past decade is to change the whole approach to looking at cancer, raise its profile and say "we can do more about it".'

This shift in focus couldn't have been done without the input and hard work of primary care, which he believes has a huge role in the cancer care pathway. Prevention and making patients aware of the lifestyle factors that will put them at risk for cancer is where primary care can really shine – smoking, for example.

'Smoking is the number one cause of cancer death, and it is a huge target for public health,' says Professor Richards.

'The new smoke-free legislation coming in on 1 July is going to be a huge step forward; partly because it will protect non-smokers in the workplace, and partly because it will give people the opportunity to give up.

'He also appreciates the role GPs have to play and the potential benefits of varenicline – which received draft approval from NICE last month.

Missed diagnoses

'I'm an ex-smoker – it took me several attempts to quit so I know it's very difficult. Having varenicline on top of nicotine replacement therapy is yet another new approach we can use and I believe it will add to the success rate.'

For all the praise Professor Richards heaps on GPs, they still have their detractors. Sir Nigel Crisp, former NHS chief executive, said last year while still in post that the number of cancers missed by GPs was 'too high' – and should be halved.

Professor Richards doesn't duck the controversy.'I recognise how difficult it is for GPs to spot which case is a cancer and which is not and that's why we need to provide GPs with better education and training,' he says. 'We need to make life easier for GPs so that they don't miss cancers.

'But we do know there's a problem and if we give GPs access to diagnostics and screening I think we will largely solve that problem.'But bowel, cervical and prostate cancer screening are already available in some form in primary care and none is without its own set of problems.

With his background in medical oncology, he isn't blind to the fact that PSA testing for prostate cancer 'isn't the most reliable of tests but it's better than nothing'.

'There's a lot of research work going on to develop better tests than the PSA,' he adds. 'If and when we've got good evidence for another test then of course we would want to bring in a screening programme.'

Professor Richards is sitting on the fence on the controversy over a vaccine to prevent cervical cancer.

He says: 'There are a lot of complex issues around the HPV vaccine and no final decision has yet been made by the JCVI – we're expecting that later in the year. One thing that is clear is that, even if we bring in a cervical cancer vaccine, we will still need to continue with a screening programme for many years.'

He is more enthusiastic over bowel cancer screening, saying it is one cancer where 'we can make a really big difference over the next five years'.

'The good news on cancer is death rates are falling. The bad news is the number of cancers is going up. We need to plan for that now. But I'm sure we will meet the challenge – we will have to.'

Professor Mike Richards on: GPs missing cancer
'We do know there's a problem and if we give GPs access to diagnostics and screening I think we will largely solve that problem.'

PSA testing
'If and when we've got good evidence for another test, then of course we would want to bring in a screening programme – but at the moment that would not be right.

The future
'The good news on cancer is the death rates are falling. The bad news is the number of cancers is going up.'

The tsar's CV The tsar's CV

• Qualified as a doctor in 1977
• Research interests include improving survival and quality of life for patients with breast cancer
• Chair of palliative medicine at St Thomas' Hospital since 1995
• Appointed national cancer director in October 1999
• Responsible for the development and implementation of the NHS cancer plan
• Also vice-chair of the national cancer guidance steering group

Professor Mike Richards on bowel cancer bowel cancer

If I think of one cancer where I believe we can make a really big difference over the next five years, it would be bowel cancer.

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