Why Britain is so bad at diagnosing cancer

THis Excellency COVID-19 The virus wreaked havoc in Britain and killed many people. But at the beginning of the pandemic, experts warned that the unintended consequences of lockdowns could kill more people. Concerns were particularly strong regarding cancer, with screenings initially suspended, routine diagnostic tests postponed, and diagnosis of less obvious cases delayed. Modeling at the time indicated that the disruptions would lead to thousands more deaths.

The gloomy predictions seem to have been correct so far. In cancers detected through early screening, death rates have returned to their levels of 20 years ago, says Nicola Barclay, a researcher at the University of Oxford. Her team’s preliminary findings suggest that in colorectal cancer, the proportion of patients surviving at least a year after their diagnosis has fallen from 79% just before the pandemic, to 76%. The damage cannot yet be measured for cancers that develop more slowly, or for rapidly progressing diseases whose symptoms may be hidden. For example, the persistent cough that characterizes lung cancer is similar to a common symptom of Covid. Recorded deaths due to coronavirus may also blur the picture: some may have had another underlying cause of death.

The pandemic and lockdowns are not the only cause of Britain’s problems in tackling cancer. Among 18 rich countries, Britain already has one of the worst five-year survival rates for three of the most common cancers: lung, colon and breast. And there were more cancer deaths per person than anyone else g7 countries (see chart). And poor Britons are more likely to get sick and die from it.

It is tempting to blame Britain’s miserable performance on mistreatment. But a large part of the gap with other countries is due to delays in treatment, especially late diagnosis. “Cancer is a progressive disease, so if you diagnose cancer early, in almost all cases your cancer outcomes improve,” says Nasser Al-Turabi of the Center for Cancer Research. United kingdom, Charity. This partly explains why the poor, who attend later, die sooner. Nine out of ten people with early stage, stage 1, bowel cancer will survive for at least five years after their diagnosis. And in stage four, when the cancer has spread, nine out of ten die.

Diagnosis is usually based on routine appointments with a GP, when patients report symptoms. Prolonging the delay in seeing patients a JB (and worse again in the most deprived areas), and concerns about the exhausted groups NHS, long before the pandemic. Even once they are referred for further testing, the target that 93% of patients with cancer symptoms should be seen by a specialist within two weeks has not been met in England for years. Another target, that patients should start their treatment within 62 days of referral, was also missed. This would have deadly consequences. A 2020 study found that every four-week delay for surgery for breast, bladder, and six other types of tumors increased death rates by 6-8%.

The government responded to the failure to achieve its objectives by abandoning it. On August 17th NHS In England, the current 10 targets for cancer will be reduced to three. For example, the two-week hold option is gone. Making the referral process simpler is in line with the advice of many experts, but some still feel anxious. “It’s an excellent opportunity to bury failure,” says Professor Richard Sullivan of King’s College London.

There is a lot of failure to bury. And in 2016, Welsh health officials traveled to Denmark to study its system. Denmark, once called the cancer capital of the world, has dramatically reduced deaths from cancer since 2007, largely through fast-tracking of cancer referrals from primary care to secondary care. Although “one-stop” diagnostic centers, where patients can quickly undergo a series of tests and scans, are relatively easy to replicate, the planning behind them is not. For the model to work, hospital managers must work efficiently, booking scans, appointments, and treatments in a limited number of slots.

The Danish model has other advantages. Its primary care system is better funded. Hospitals have more Magnetic resonance imaging And ct Scanners for each patient, and the radiologists who will use them (in England, frustrated professionals sporadically strike). Visit the Rigshospitalet in Copenhagen, the Danish capital, and cancer surgeons are praising the da Vinci robots they use for complex surgeries. Most importantly, specialist care is centralized, with patients bussed in from rural areas to receive high-quality care.

Better outcomes also require recognizing that 30% to 50% of cancer cases are preventable. Cancer is predominantly a disease of the elderly, but poor nutrition may explain the alarming rise in colorectal cancer cases among young people. Ultra-processed foods make up more than half of the typical British diet: more than anywhere in Europe. For all of Denmark’s progress, the death rate from cancer is still higher than that of Britain, perhaps in part because Danes smoke more.

Overall, there’s still a lot to be happy about fighting cancer. In the long term, survival rates, even in Britain, are steadily improving. And diagnoses are likely to improve further when people can do some cancer tests themselves, at home, even before symptoms appear. And more vaccines will be available to prevent cancer, too. However, this comes as little comfort to those who have been lost during the pandemic. “Once you delay diagnosis or delay treatment, you’re in trouble,” says Professor Sullivan. ■

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