Early Diagnosis Initiative

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Contact the Early Diagnosis Team

Do you have a question about early diagnosis?

The earlier the stage which cancer is diagnosed, the better the chance of survival. And so diagnosing people at an earlier stage is a key part of our strategy to improve cancer survival and reduce the number of people dying from the disease. 

Cancer Research UK has been working in the field of early diagnosis for more than a decade.  This was initially as part of the National Awareness and Early Diagnosis Initiative (NAEDI) introduced following the Cancer Reform Strategy for England in 2007. Since 2014, we have also significantly invested in Early Detection research. We champion an evidence-based approach to identifying and embedding the developments that are needed to secure a meaningful reduction in the diagnosis of late stage disease through earlier disease detection. 

We operate across the entire diagnostic pathway, and with researchers, the public, patients, health professionals and key opinion leaders to drive high-quality research and the implementation of evidence into policy and practice, to achieve improved outcomes for patients. We work in partnership with a wide range of organisations in delivering this work.

How do we achieve early diagnosis of cancer?

There is a lot of interest in improving cancer outcomes through moving patients from a late stage diagnosis to an earlier or early one. But the challenge is knowing what exactly is needed in order to achieve this.

What is clear is that there is no one thing – achieving early diagnosis is a complex problem that needs to be tackled on a range of fronts at all levels of the system. It’s also not something we can solve purely on the basis of what is known – we need action and research if we are to make a real, significant difference and achieve our ambitious ambitions. This is fundamental to CRUK’s approach to Early Detection and Diagnosis.

We accelerate the adoption of research and evidence into policy and practice for patient benefit by:

  • building and maintaining a comprehensive overview of early diagnosis evidence and research
  • horizon scanning for interventions that will/may contribute towards stage shift
  • including key opinion leaders and health professionals at the earliest opportunity
  • exploiting current/future policy for Early Diagnosis gain (i.e. influencing on the RDC agenda)
  • building the evidence base where it is lacking (e.g. ACE MDC)
  • undertaking data analyses and shaping the analyses of others to reinforce the case for change
  • providing evidence-based information to the public and health professionals
  • nurturing the early diagnosis research and wider community, shaping the research undertaken and facilitating its implementation (e.g. CRUK ED research conference)
  • building and maintaining extensive influencing networks
  • bringing people together to shape an agenda and influence the flow of research and evidence, particularly in key/challenging areas (e.g. lung screening workshop, AI for bowel screening mtgs)
  • demonstrating significant domestic and global thought leadership in early diagnosis (e.g. ICBP, CRUK ED waterfall)

The CRUK Early Diagnosis Waterfall diagram has been developed to help articulate the things we think will help to reduce the burden of late stage cancer. It’s built on data where possible – such as estimates of the impact of different screening interventions – and expert input where it is not. It reinforces that no one thing will achieve the stage shift we seek; we need coordinated action on a range of fronts and at all levels to make the difference. We’ve found our waterfall to be a useful conversation starter, and an excellent prompt for further questions and discussions. We will continue to horizon scan and keep the waterfall up to date as more evidence arises, and are keen to continue to be as responsive as we can to suggestions for how it can be improved and built upon.

Waterfall diagram of Early Diagnosis work

In our work, we aim to make a real, meaningful shift in the stage distribution of cancer that will mean fewer people being diagnosed with advanced disease and dying as a result. In these efforts, we are aware of the potential to cause harm as well as benefit. For screening approaches, these are well-known and include false positives, false negatives, overdiagnosis, and false reassurance, but they can also apply to early diagnosis approaches aimed at individuals with symptoms.

It is important to us that the evidence for change is demonstrating real benefits to patient mortality and not artificially inflating survival statistics, for instance our funded research investigating urgent referral pathways and our influencing around the CAP trial.

We engage with data, academics, health services and other stakeholders across all cancer sites. By ensuring we understand the landscape we are ready to utilise all opportunities, aiming to ensure patients get the best possible chance for an early diagnosis and the best possible outcomes.

Insights from our research have fed into the development of national public awareness activity, including Detect Cancer Early in Scotland and Be Clear on Cancer in England, which has reported positive impact on awareness of cancer symptoms, GP attendances with relevant symptoms, urgent cancer referrals and, in some instances, cancers diagnosed at an earlier stage.

Our understanding of cancer diagnosis in primary care has been improved by studies investigating which symptoms patients present with prior to a diagnosis. This has helped to inform cancer referral guidelines and supported policy to increase GP direct access to diagnostic tests.

Our research through the Accelerate, Coordinate, Evaluate (ACE) programme's assessment of innovative practice and our Early Diagnosis Advisory Group policy-relevant funding committee has supported excellence in the field of early diagnosis research.

We have engaged with stakeholders around the world to support the formation of the International cancer benchmarking partnership (ICBP), an innovative collaboration of clinicians, policymakers, researchers and data experts around the world, benchmarking international variation, identifying best practise and generating insight for policy and practise change. The ICBP has highlighted the contribution of stage at diagnosis to international survival differences. This included the finding that GPs in the UK are less likely to refer patients for tests at the earliest opportunity than GPs in similar countries.

Research into early diagnosis has been made possible by major improvements in data and intelligence over the last decade. The publication of national data on patient’s stage at diagnosis shines a light on areas of need and provides a baseline to measure improvements. The Routes to Diagnosis methodology allows us to identify the way cancer patients are diagnosed and the impact this has on survival, showing us how critical it is to reduce emergency presentations.

The National Cancer Diagnosis Audit (NCDA), which includes data on the diagnostic pathway for thousands of cancer patients, has emphasised the key role of primary care, revealing the extent and causes of avoidable delays.

Timeline of the Early diagnosis initiative

Despite the significant developments, nearly half of patients with a known stage are diagnosed at stages III or IV, and almost 1 in 5 newly diagnosed cancer patients in England still receive their diagnosis via an emergency route. CRUK continue to build on our efforts so that fewer patients are diagnosed with late stage disease, more have the option of potentially curative treatments and all patients have the best possible experience.

Improvements to the bowel screening programme, lung health check pilots, changes to referral guidelines and multidisciplinary or ‘rapid diagnostic’ centres (M/RDCs) can all contribute to reducing late stage burden, but more needs to be done.

We are helping to shape and fund exciting research supporting the earlier diagnosis of cancer. The CRUK funded CanTest programme is exploring development and implementation of new and improved tests in primary care. Our policy relevant early diagnosis research portfolio continues to produce key insights.

2019 saw the Cancer Research UK Early Detection (EDx) programme begin its boldest initiative yet; the creation of an International Cancer Early Detection Alliance. This will unite six of the world’s foremost centres of excellence in EDx research, in the US and UK, in a collaborative virtual institute and further build the research pipeline, to generate the interventions of the future. 

The translation of current early diagnosis research into practice, coupled with significant advances in and rapid translation of early detection research is crucial to achieving our ambition and improving patients’ lives. We will continue to engage across the pathway, supporting evidence-based change and readying the healthcare care system for the translation of new research into practise.

The early diagnosis research conferences (formerly NAEDI research conferences) bring together researchers, clinicians, patients and policy makers to share and discuss the latest research findings, their impact on policy, and implications for the future of earlier cancer diagnosis.

How can CRUK support you?

The Early Diagnosis newsletter keeps you up to date with developments in the early diagnosis field, including the CRUK ED conference, grant opportunities, new resources for healthcare professionals and key findings/learnings from ongoing research.
The healthcare professional twitter is primarily aimed at GPs, but we tweet about resources, events, campaigns and anything that is relevant to health professionals.

The health professionals web pages contain resources to support your day to day work and service planning.

Our facilitator programme offer tailored practical support for health professionals and organisations to improve the way they manage cancer.

For those interested in research opportunities our policy focused Early Diagnosis Advisory Group calls for expressions of interest from research project in spring each year, funding policy relevant research or activities that are adding to the scientific evidence base to achieve earlier diagnosis. Other research schemes can be found here.