Early diagnosis of cancer: systems approach to support clinicians in primary care

The substantial deficit in primary care contacts and diagnostic testing for suspected cancer during the covid-19 pandemic fed into a backlog of patients awaiting investigations.1 Modelling using NHS datasets suggests that these delays will result in around 3500 additional deaths from breast, colorectal, oesophageal, and lung cancer over the next few years in England alone.2

Delays in cancer diagnosis vary according to type of cancer. For example, the median time between presentation in primary care and referral for specialist assessment in England is 24 days for multiple myeloma compared with 0 days for breast cancer.34 Urgent referral pathways are designed to expedite cancer diagnosis for patients with concerning symptoms, and testicular and breast cancers are far more likely to be diagnosed through this route (73% and 71%, respectively). By contrast, only 6% of brain cancers and 20% of leukaemia cases are diagnosed through urgent referral pathways.5

The differential diagnosis is wider for patients with non-specific symptoms, so multiple primary care consultations are often required to establish the diagnosis.6 Referral processes also depend on the severity of presenting symptoms, and many patients with pancreatic, liver, and stomach cancers are diagnosed during emergency hospital admissions.4

Current approaches to improving diagnostic accuracy and timeliness place most weight on improving the initial primary care consultation. However, the diagnostic process is more often dynamic, involving many different encounters and healthcare professionals. A wider approach that shifts the approach away from individuals and onto the whole system is likely to have a bigger impact.