• Pockets of England are seeing falling early stage diagnosis rates
  • National diagnosis rate has remained static for two years
  • Investment in workforce will be crucial to meet 2028 target for 75 percent early stage diagnosis, experts say

The proportion of cancers being diagnosed at an early stage has dropped in several areas across England, according to recently released data.

The figures from Public Health England span from late 2011 to the first half of 2017.

Nationally, the rate of early cancer diagnosis has been static at 52 per cent for the past two years, but rates vary across England. 

Most clinical commissioning groups diagnosed over half the cancers in their area in the early stages. Most are also increasing their rate of early diagnosis. However, 16 have seen their rate decline.

At North East Essex CCG, the early stage diagnosis rate has fallen nearly 5 per cent from the second quarter of 2013 to the second quarter of last year. 

The CCG told HSJ the reasons for the drop are “multifaceted”, although it pointed to “some deterioration” in the number of people coming forward for screening as part of the NHS’s national cancer screening programmes.

It said the declining diagnosis rate required “ongoing focus across our system, including health and public health colleagues, as well as patient education campaigns”. A spokeswoman also said the faecal immunochemical test, or FIT, will be rolled out to primary care next year. 

The NHS is planning to begin the FIT rollout in England by the end of the year. It is considered easier to use than the current test and will result in 200,000 more people getting screened for bowel cancer, according to PHE.

Early stage diagnoses also declined at Swindon CCG. A spokeswoman said: “In Swindon, we are introducing a quality improvement scheme within general practices, linked to improving early cancer diagnosis rates.”

Early diagnosis is indicative of probable outcome as, generally, an earlier diagnosis leads to a greater chance of successful treatment.

Prime minister Theresa May told the Conservative party conference in October that NHS England will increase the rate of early diagnosis to 75 per cent by 2028.

Matt Case from Cancer Research UK supports the ambition to diagnose three in four cancers at an early stage, but he told HSJ “the scale of the challenge is substantial” and the new figures show “much more needs to be done to improve early diagnosis of cancer”.

He added that, to increase the diagnosis rate by 50 per cent, “GPs need to be able to refer more patients, diagnostic tests need to be carried out more swiftly, and new early diagnostic initiatives need to be rolled out effectively”.

However, a shortage in the diagnostic workforce is a barrier to progress. “Without a fully-funded plan for the workforce, the prime minister’s commitment to early diagnosis will simply not be achieved,” he said.

Professor Hashim Ahmed at Imperial College London, an expert in prostate cancer diagnosis and chair of an NHS England cancer clinical expert group, told HSJ: “We need greater investment in workforce and we need to be more imaginative about the workforce.”

Physician assistants could be trained to carry out some diagnostic tests, he added.

CCGRate in 2013 Q2Rate in 2017 Q2Change
North East Essex CCG 55.4% 50.8% -4.6%
Blackpool CCG 47.7% 44.1% -3.6%
Swindon CCG 52.8% 49.3% -3.5%
Rushcliffe CCG 55.5% 52.4% -3.1%
Bath and North East Somerset CCG 54.9% 52.3% -2.6%
West Norfolk CCG 55.8% 53.6% -2.2%
Cambridgeshire and Peterborough CCG 57.9% 55.9% -2.0%
West Suffolk CCG 61.0% 59.1% -1.9%
Mansfield and Ashfield CCG 39.6% 37.9% -1.7%
Great Yarmouth and Waveney CCG 53.9% 52.4% -1.5%
Havering CCG 51.6% 50.4% -1.2%
Bradford City CCG 50.7% 49.7% -1.0%
Bedfordshire CCG 57.3% 56.6% -0.7%
Calderdale CCG 49.4% 48.7% -0.7%
Mid Essex CCG 55.9% 55.2% -0.7%
West Cheshire CCG 51.7% 51.1% -0.6%
       
Rates are one-year rolling averages