Our policy on early diagnosis
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Many types of cancer are detected at a late stage, when treatment options are limited, and prognosis is poor. Being able to detect cancers earlier can increase treatment options and substantially improve survival. There is a pressing need for a paradigm shift in our ability to accurately detect and diagnose cancer at an earlier stage to transform health outcomes.
Our policy on diagnostics
Our growing and ageing population means that more than half a million people will be diagnosed with cancer each year across the UK by 2038-40. This increase in patient need, plus welcome efforts to improve earlier diagnosis means we will need to do more tests in future.
Waiting times have increased and the services which deliver cancer tests are struggling to keep up with demand. Diagnostics is facing a range of challenges including workforce and capital, but there is also opportunity on the horizon with new service models and innovations in genomics and artificial intelligence.
With a UK General Election on the horizon, we have set out our recommendations to deliver change in A Full Diagnostic, outlining the current state of play on diagnostics in England and how we can address issues to deliver a world-class cancer service.
Imaging plays a major role in the diagnosis and treatment of cancer, as well as many other conditions. Imaging tests such as MRI, CT and X-Ray are all used to investigate potential cancer symptoms.
Pathology plays a major role in the diagnosis and treatment of cancer, as well as many other conditions. Pathology is comprised of 19 different disciplines and our research focussed on the most relevant to cancer: cellular pathology (which encompasses both histopathology and cytopathology); blood sciences; and molecular pathology.
Endoscopy plays a major role in the diagnosis and treatment of cancer, as well as many other conditions. Endoscopic tests such as gastroscopy and colonoscopy are used to investigate potential cancer symptoms. Colonoscopy is also a vital follow-on test for bowel cancer screening.
Our policy on screening
Cancer screening is meant for healthy people with no symptoms at all. Screening looks for early signs that could indicate cancer is developing. It can help spot cancers at an early stage, when treatment is more likely to be successful and the chances of survival are much better. In some cases, it can even prevent cancers from developing at all, by picking up early changes that can then be treated to stop them turning into cancer.
Screening is for people with no symptoms to pick up cancers (or precancerous changes) before symptoms have a chance to develop. It is important for people to recognise what is normal for them and speak to their GP if they notice any unusual changes, as offering screening at certain age ranges does not mean that someone with symptoms shouldn't be offered appropriate tests.
We regularly respond to consultations by the UK National Screening Committee (UK NSC) regarding new and improved screening programmes. Developing standardised processes for how evidence and research is gathered for new screening technologies is vital to improve and optimise our screening programmes.
CRUK response to the Sir Mike Richards review of cancer screening programmes (2019)
Bowel screening is the best way to diagnose bowel cancer early. Early diagnosis is crucial - patients diagnosed with bowel cancer at the earliest stage have a better than 90% chance of surviving for five years, whilst for those diagnosed at the latest stage this drops to just 6.6%.
We would like to see the current programme made even more effective by:
Optimising the Faecal Immunochemical Test (FIT)
Each UK nation has taken a different approach to the optimisation of bowel screening but none are currently meeting UK NSC guidelines.
UK nations must move towards UK NSC recommendations offering screening for bowel cancer, offering screening every two years to people between the ages of 50 and 74 years old in the UK using the faecal-immunochemical test (FIT) at as low a threshold as possible (down to 20µg/g).
It is vital that the optimisation of screening is matched with increasing capacity for pathology and endoscopy to meet additional patient need.
Improving participation
Bowel cancer screening uptake is lower than other national cancer screening programmes. There is considerable variation in participation levels in bowel screening across the country, and certain people, such as those from more deprived groups, are less likely to participate in screening. We call on policymakers in all four nations to set an ambition to break down barriers to participation in the bowel cancer screening programme.
Cervical screening is available to anyone with a cervix between the ages of 25 to 64 in the UK. The screening test facilitates the identification of changes in the cervix which, if left untreated, could develop into cancer.
HPV Primary Screening
England, Wales and Scotland are using HPV primary screening. HPV primary screening tests the cervical cells for the HPV virus first. The laboratory will look to see if you have high risk HPV. If high risk HPV is found, the laboratory will test your sample for cell changes.
In Northern Ireland, they look for changes in the cervical cells first. They then test for HPV if there are cell changes. We welcome the commitment from Northern Ireland to start using HPV primary screening in the future. As HPV-primary testing is more accurate and sensitive than cytology, we would encourage this transition to happen as soon as possible.
Screening intervals
The UK NSC recommend that all people with a cervix aged 25 to 64 are invited for cervical screening every 5 years. This has changed from 3 to 5 years because the test used in cervical screening has changed. The new test is known as HPV primary screening and is more accurate at detecting who is at higher risk of developing cervical cancer. This means the intervals for those who are not at high risk can be safely extended from 3 to 5 years.
Screening using mammography is an effective way to diagnose breast cancer early. Early diagnosis is important because it hugely increases the chances of survival.
Risk adaptive breast screening
We welcome efforts to improve the current breast cancer screening programme, including the link between breast density and breast screening. Cancer Research UK is currently supporting a £2.8 million study into risk adaptive breast screening, which will help inform national policy in this area.
Lung cancer screening is specifically targeted at those most at risk of developing lung cancer: people aged between 55 and 74 who either smoke or used to smoke.
Lung screening involves having an assessment with a health professional to find out about your lung cancer risk. If this shows that you are at higher risk of lung cancer, you will be invited to have a low-dose CT scan to take a detailed picture of the lungs.
The Secretary of State for Health and Social Care announced the rollout of a new targeted lung cancer screening programme in England which aims to reach 100% coverage by March 2030. But the other UK nations still need to get started. Governments and devolved administrations in Wales, Scotland and Northern Ireland must make a ministerial commitment to rolling out a national targeted lung cancer screening programme to ensure everyone who needs it can benefit from lung screening, no matter where they live.
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