Early cancer diagnosis is vital, but treatment delays are causing harm to patients

A good news story about cancer was released at the start of this year by NHS England.1 Over the period between September 2023 to August 2024, 58.7% of cancers (120 958 of 206 038) in England were diagnosed at stage 1/2. This is a 2.7% improvement on pre-pandemic levels. Early-stage diagnosis should mean that patients will need less cancer treatment and have greater cure rates. The story was picked up well by the media, but soon questions were raised as to how good this news really is. It is true that about 1000 new lung cancers had been detected between September 2023 to August 2024 with the new, innovative lung cancer screening roll-out (75% at early-stage disease). But breast screening rates were down (71% to 65%) and lengthy delays in routine clinical investigations meant that many patients were receiving a late diagnosis. So, is this a real and meaningful improvement? In 2018, NHS England announced a target of improving early cancer diagnosis from around 55% of cases to 75% by 2028.2 So, the fact that these new data find that only 58.7% of cancers are diagnosed early suggests we are woefully behind. The actions prescribed in 2018 to reach NHS England’s target have sadly in the main part failed.34

Do such positive press releases help? Media attention can raise public awareness of the need to present early with symptoms and attend screening, but this was not the headline messaging. Self congratulation can precipitate complacency and risks masking the broader cancer crisis. Primary care is at breaking point, poor access to cancer treatment and delays mean the 62 day target from referral-to-treatment has not been met since 2015. Approximately 3000 patients a month wait three months to start cancer treatment.5 Every four weeks of delay in treatment can lead to around a 10% increase in cancer mortality.6 In 2023, 84% of cancer service leaders were concerned that workforce shortages affected the quality of care they were able to provide to patients.7 It is no good diagnosing patients with early-stage cancer if by time of treatment they are late-stage. Improved cancer outcomes are the real target, and sadly although UK cancer survival has improved in the past 50 years, it still lags behind many other high income countries,8 ranking 28th out of 33 countries with similar wealth for 5 year stomach and lung cancer survival.9 While there is pressure on all waiting lists, cancer waiting lists are the most urgent and deadly. If we cannot cope with treating our cancer patients now, how will we deal with the predicted 30% increase in cancer cases by 2040?10

But, among this, there was some really good news recently. Against the odds and following the determined work of the Health and Social Care Select Committee, Wes Streeting, Secretary of State for Health and Social Care for the UK, announced his decision to publish a National Cancer Control Plan (19 December 202411). The International Cancer Benchmarking Partnership has shown unequivocally that countries with consistent national cancer plans have better cancer outcomes.8 Enhanced cancer care can also yield an economic dividend. Investment in workforce and equipment in the UK to the mean level of high-income countries could prevent over 30 000 deaths from 11 common cancers by 2030, providing net economic benefits based on a value-of-life-year-gained approach of £24.41 billion—a return of £17.30 per £1.00 invested.12

But after what has been described as a decade of unrivalled mismanagement of cancer services,13,14 the cancer plan needs to be radical, big, bold, and brave. The UK needs to be a leader in cancer care, not a lagger.14 Incremental change will fail. We need strategies to supercharge early diagnosis and treatment, with ambitious accountable targets that are met. If we do not, this opportunity will be lost and UK cancer patients will continue to die needlessly. We must not accept failure as good news.