House of Commons - Public Accounts

Select Committee on Public Accounts Second Report

1 Improving the prevention and early detection of cancer

1. Rates of cancer incidence are increasing across the developed world. Between 1971 and 2000 total cancer incidence increased by 21% for men and 39% for women (Figure 1). The pattern varies among the major cancers. Incidence has increased sharply for breast and prostate cancer, much more slowly for bowel cancer and fallen sharply for lung cancer among men, but not women. There are a number of causes underlying this, in particular the ageing population, though the reasons for increases in some cancers are not fully understood. Nevertheless, it is estimated that up to two thirds of cancers are preventable.[2] Figure 1: Changes in cancer incidence and mortality rates in the last 30 years

2. During the same period mortality fell by 18% for men and 7% for women (Figure 1). For men, the large fall is attributable to a sharp decline in cases of lung cancer. For women, falls in breast and bowel cancer mortality have been partially offset by increases in lung cancer mortality.

3. Despite the fall in lung cancer incidence, smoking remains the largest single factor influencing the overall level of cancer incidence and mortality.[3] In measuring the success of its Stop Smoking programme, the Department considers that a person has successfully quit smoking if they abstain for four weeks. The long-term effectiveness of these measures is less clear, since it is estimated that only about 30% of people quitting will still not be smoking 12 months later. There is a seven-fold variation in the proportion of quitters between the Strategic Health Authorities with the largest and smallest numbers of quitters.[4]

4. English survival rates from cancer are still well below the best in Europe, especially for people in deprived areas of England. A key factor is the tendency of some patients, especially the old and those from deprived areas, to be diagnosed at a later stage of the disease.[5] There are several contributory factors to this later diagnosis. No one knows how much each factor contributes to delays:

Delay in patient awareness. In the NHS Cancer Plan in 2000 the Department undertook to develop a comprehensive cancer public awareness programme, which is still awaited.[6] Awareness of symptoms remains low among the population at large, despite the success of particular targeted campaigns.[7]
Delay in patient coming forward with symptoms. The Department has commissioned several pieces of research to investigate the reasons why patients with symptoms delay consulting their GPs.[8] This research, due to be published shortly, will form the basis for strategies to promote awareness.[9]
Delay in onward referral from GPs. It is not known to what extent GPs' failure to identify cancer symptoms early contributes to poor outcomes. Half of GPs responding to the NAO survey were not finding existing guidance helpful. They frequently seemed to think guidance was not necessary,[10] revealing a complacency evidenced by the large numbers of cancer sufferers not initially referred urgently by GPs. Patients referred urgently by GPs are now almost always seen by specialists within 2 weeks but those that are not (one third or more of patients subsequently diagnosed with cancer) can take several months to be seen by a specialist.[11]
Delay in carrying out diagnostic tests. Delays in carrying out vital diagnostic tests in radiology, endoscopy and pathology are common throughout England, but are difficult to quantify because this information is not collected in a standardised format on a day-to-day basis by the NHS.[12] The NHS is greatly expanding training facilities and increasing efforts to recruit staff in these areas, partly by restructuring services to widen access to these specialisms. However, in recent years vacancies for radiographers and pathologists have continued to rise.[13]