Early diagnosis of cancer: advances and new evidence

The National Awareness and Early Diagnosis Initiative (NAEDI) was launched in England in November 2008 as part of the Government’s strategy to improve cancer outcomes. Much of the evidence base underpinning the initiative was published in a seminal supplementary issue of the British Journal of Cancer in December 2009. This week a new NAEDI supplement for the same journal was published as an advanced online publication highlighting advances that have been made in the intervening years, both in terms of achieving earlier diagnosis of cancer and in the intelligence achieved from the continued use of routinely collected data. CCHSR research has featured heavily in this arena and this is reflected by the five papers featuring a contribution from CCHSR members.

The first of these papers considers variation in emergency presentation prior to a diagnosis with cancer. Previous work has shown that older patients, women and those from more deprived backgrounds are more likely to experience an emergency presentation, but this latest paper shows that this pattern is highly variable across cancer sites and in the case of age and gender the association is in the opposite direction for some cancer sites.

The second paper describes the relative length of patient and primary care interval and how these vary by cancer diagnosis. The patient interval is the time period between symptom recognition and first presentation to a healthcare professional and the primary care interval describes the time between first presentation and referral to a specialist. This analysis may help to optimise the choice of interventions for different cancers and with either a community or system healthcare focus.

The CCHSR contribution also forms part of a pair of papers which fall into the “size of the prize” category, considering the potential impact of delayed diagnosis on survival. Specifically these papers look at the consequences of inequalities in stage at diagnosis. The first paper considers the impact of deprivation and gender inequalities in stage at diagnosis for melanoma patients whist the second considers age inequalities in older women with breast cancer.

The final CCHSR paper with CCHSR contributions discusses missed opportunities for earlier diagnosis from a theoretical standpoint. It includes considerations of the factors involved as well as the epidemiological ‘signals’ suggestive of missed opportunities concluding with a conceptual framework in which future interventions may be designed.

In these efforts CCHSR have collaborated with workers from the Universities of Leicester, Durham, Bangor, and Aarhus, University College London, Baylor college of Medicine, RAND Europe and Public Health England. We are also joined in the supplement by Cambridge based colleagues (papers here and here). Check back soon for forthcoming blogs on the individual papers.

All of the papers from the supplement are open access and can be found on the British Journal of Cancer website.

Lyratzopoulos G, Saunders CL, Abel GA, McPhail S, Neal RD, Wardle J, Rubin G (2015a) The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers. Br J Cancer e-pub ahead of print 3 March 2015; doi:10.1038/bjc.2015.40. (Click here)

Lyratzopoulos G, Vedsted P, Singh H (2015b) Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer e-pub ahead of print 3 March 2015; doi:10.1038/bjc.2015.47. (Click here)

Rutherford MJ, Ironmonger L, Ormiston-Smith N, Abel GA, Greenberg DC, Lyratzopoulos G, Lambert PC (2015b) Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma. Br J Cancer e-pub ahead of print 3 March 2015; doi:10.1038/bjc.2015.50. (Click here)

Rutherford MJ, Abel GA, Greenberg DC, Lambert PC, Lyratzopoulos G (2015a) The impact of eliminating age inequalities in stage at diagnosis on breast cancer survival for older patients. Br J Cancer e-pub ahead of print 3 March 2015; doi:10.1038/bjc.2015.51. (Click here)

Abel GA, Shelton J, Johnson S, Elliss-Brookes L, Lyratzopoulos G (2015) Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. Br J Cancer e-pub ahead of print 3 March 2015; doi:10.1038/bjc.2015.52. (Click here)

 

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.