This page looks at the evidence for early diagnosis of cancer, barriers to early presentation and the cost of early diagnosis.
There is a wealth of information that indicates the potential gains that can be achieved if improvements are made in the early diagnosis of cancer.
Findings from recent international comparisons show that one and five year survival rates in England remain significantly lower than many comparable countries.
We know from routes to diagnosis work conducted by the National Cancer Intelligence Network (NCIN) that between 2006-2008, 24% of all cancer patients in England presented as emergencies often with later stage cancers. For some cancers, such as lung cancer, this figure is even higher with 39% of patients presenting as emergencies. Importantly, emergency presentations were found to be correlated with lower one-year survival rates.
It is estimated that if England was to achieve cancer survival rates that matched the best in Europe, then up to 10,000 cancer deaths each year could be avoided through earlier diagnosis and access to optimal treatment.
In a comprehensive review of the factors associated with increased time to diagnosis across the most common cancers (Macleod et al, 2009), non-recognition of the seriousness of a symptom was the main patient mediated factor, followed by fear of cancer and treatment. Other barriers include not wanting to waste the GP's time and difficulty getting an appointment.
Cancer Research UK and the Department of Health undertook qualitative research in 2010 with cancer patients, the general public and GPs which looked at the perceived barriers to, and promoters of, presentation. Again, typical barriers to presentation included:
- accessing a GP
- concern about wasting the doctor’s time
- being too busy
- fear of result
These barriers continue to delay people from presenting to their GP sooner. A recent study on the differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK highlighted that in the UK, 15% of people were put off seeing their doctor because of embarrassment, 34% were worried about wasting their doctor’s time and 28% said that worry about what the doctor would find might put them off going.
‘Delay’ has been investigated in relation to many disease types, but arguably the largest amount of enquiry is in the field of cancer. As early as 1938, a paper was published titled ‘The culpability for delay in the treatment of cancer’ (Pack and Gallo, 1938).
Since this time, there has been a great deal of interest in ‘patient delay’ and cancer (see Andersen et al, 2009 for an interesting discussion). Some of the studies have been descriptive observational studies, often relying on examination of medical records or questionnaires, to assess the extent of ‘delay’ for particular cancer types. Others have sought to establish factors associated with delay and have highlighted the importance of individuals not realising the seriousness or significance of possible symptoms (Ramirez et al, 1999; Macdonald et al, 2004; Macleod et al, 2009).
Studies have also drawn upon qualitative methods to explore help-seeking and delay with individuals diagnosed with cancer. Smith and colleagues (Smith et al, 2005) have brought together many of these studies in a qualitative synthesis. The analysis of 32 papers across more than 20 different cancer types highlighted key similarities irrespective of cancer site and country. The main themes associated with delay in presentation were:
- Recognition and interpretation of symptoms
- Fear of consultation (with respect to embarrassment and to the idea of cancer itself)
- The patient’s gender and the sanctioning of help-seeking also affected help-seeking
It’s helpful to realise that there are many factors across a number of different levels which can influence help-seeking behaviour, just as there are many which influence interpretation. As Una Macleod and colleagues wrote: ‘Overall, research into the risk factors for patient delay indicates that presentation with cancer is not a straightforward or linear process. Knowledge of symptoms and risk may be necessary, but are not sufficient to determine help seeking for cancer. People’s attitudes, beliefs and social context clearly influence the process of medical help seeking’ (Macleod et al, 2009).
Awareness of a lump or swelling as a symptom of cancer is high in Britain. However, awareness of other key signs and symptoms of cancer, as well as risk factors, is low. For example when 2,216 adults taking part in a Cancer Awareness Measure survey were asked to recall possible signs or symptoms of cancer from memory, only 29% of people mentioned unexplained bleeding and only 5% mentioned a cough.
There has been some early work carried out by the Department of Health which features in the report, ‘The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS’. Based on the model used in this report, earlier diagnosis is generally cost-effective, but not cost-saving. If people are diagnosed earlier, the main benefit is a substantial improvement in health outcomes.
Be Clear on Cancer is a cancer awareness campaign led by Public Health England, working in partnership with the Department of Health and NHS England. This page contains links to documents that we hope you find useful. Please note however that the views or opinions expressed within those links are not necessarily those of Cancer Research UK.
Question about cancer? Contact our information nurse team