The prevailing narrative surrounding cancer care in the UK is one of self-depreciation. Patients are assumed to be reticent about seeing their GP when they develop symptoms, either due to the stereotypical British stiff upper lip, or because the Great British Public is wallowing in such ignorance that it is in dire need of yet another awareness raising campaign.GPs are derided for being a barrier to referral, and are generally regarded as being in constant need of retraining.
Even if you do recognise the symptoms and fight your way through the wilful ignorance of your GP, we are led to believe that the sole purpose of NICE is to deny you the life-saving treatment you would receive in any other developed nation. The end point is the recurring complaint that the UK ‘lags behind’ the rest of the world.
We are so used to hearing the negative voices that envelop UK cancer care that it can be rather startling to hear the occasional good news story that somehow slips through into the media.
The recent report that GPs are actually really rather good at spotting cancer is a such an example. This national audit of cancer patients demonstrated that most patients presenting to their GP with symptoms of cancer are referred after only one visit – with a median referral time of zero days for these patients – meaning that they were referred on the day of presentation.Overall, more than 80% were referred within two consultations, and those that took longer tended to be cancers that were harder to spot in the first place.
The lead author Georgios Lyratzopoulos said: ‘Much is assumed about GPs spotting cancer late, but these data show that in the great majority of cancers the suspicion is made promptly.’
The overall picture in cancer care is surprisingly positive also, with cancer death rates on the decline, and projected to continue to fall over the next two decades. The World Health Organisation Cancer Mortality database places the UK comfortably in the middle of the table, just above Germany – so maybe British patients aren’t so neglectful in their health-seeking behaviour after all.
Whenever the evidence points in a positive direction, the good news is frequently welcomed with an air of reluctance – you can almost hear the grinding of gritted teeth in the sound bites.
Sara Hiom, early diagnosis director at Cancer Research UK, reacted to the referrals audit, saying: ‘Progress is clearly being made, but one in five people have to make more than two visits to their GP.’
Likewise, the Department of Health responded to news of falling death rates by writing that ‘these figures reflect improvements in cancer services, but we know there is still more to do.’
Of course we should not be complacent, but the dominant perception that cancer care in the UK is somehow inferior to much of the developed world should worry us – because there are too many vested interests that depend on keeping up this bleak outlook.
Politicians benefit, as they know that declaring ‘we must do better’ is a vote-winner. Cancer charities are nervous about good news because their funding depends on their still being a job to do. Rightwing commentators in search of a US-style health service will relish anything that allows them to bash the NHS.
This is no mere philosophical debate, but a key driver for major NHS policy – the NHS Mandate seeks to save lives by reducing mortality rates from cancer, but then demands an improvement in one and five-year survival rates – the favoured statistic of those who seek to downplay UK performance and a dangerously unreliable method for comparing one country with another.
If we allow this misdiagnosis of cancer care in the UK to continue, we will be vulnerable to accepting treatments we do not need – increased screening, over-diagnosis and over-treatment in particular – and all the associated harms of unnecessary intervention. It is time to stop whispering, time to stand up for the NHS, and say, loud and clear: ‘Actually, we do pretty well.’
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.