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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