Early this month to mark World Cancer Day we published an article in the Western Mail highlighting our pioneering work on early cancer diagnosis. To find out more read our blog below…
Cancer Research Wales has risen to the critical challenge of early cancer diagnosis in Wales, and over the last 2 years alone has invested more than £1.25M in this area. The problem is being tackled on two fronts in the form of population and laboratory based studies. Breakthroughs in research and improvements in service delivery now mean that more people survive cancer than ever before. However, there is still much to be done as international tables demonstrate that when it comes to survivorship Wales, like the rest of the UK, lag behind other many other nations with similar healthcare systems, with late diagnosis thought to be a major reason. Recent data published by the Wales Cancer Intelligence Unit show that more than half of Wales’ most common cancers are diagnosed at a late stage. A stage when they are more difficult to treat, manage and cure.
The issues that contribute to late diagnosis are complex and multi-factorial. They can occur at the level of the patient, who may be unaware of symptoms, or simply embarrassed to trouble the GP. Also as symptoms of cancer are often the same as many other prevalent, yet less serious conditions, a number of GP visits may be required before a patient is finally referred to secondary care for necessary tests. Even then, delays within the hospital setting can add to the time taken before a diagnosis is eventually made.
The fact that around 90% all patients will first visit their GP with cancer-related symptoms, underlines the important role that primary care has in cancer diagnosis. Although NICE guidelines for cancer referral have recently been introduced, the vagueness of many cancer symptoms, and the lack of routine cancer specific tests in primary care, represents a formidable challenge for GPs, who may only encounter a cancer patient once every 800 consultations.
Through funding from Cancer Research Wales, The North Wales Centre for Primary Care Research is undertaking a major 5-year study which will seek to identify the barriers to early cancer diagnosis as they exist in primary care. The Think-Cancer initiative will explore perceived cancer knowledge and levels of confidence, readiness to refer, adherence to NICE guidelines, and the learning styles and preferences of GPs as they relate to cancer.
As large inequalities exist across Wales with respect to cancer incidence and mortality, the influence of practice demographics and social factors will also be examined. At the end of the study it is hoped that interventional tools can be designed that will better help GPs in the above areas, as well as further add to the evidence base.
In other areas Cancer Research Wales, is funding the development much needed blood tests will help GPs quickly diagnose some common cancers with greater accuracy than ever before, in an effort to transform GP surgeries into diagnostic centres of excellence for cancer. The one test, developed by Professor Dean Harris and his team at Swansea University, uses lasers of light shone through a small volume of blood taken from the arm, to capture the unique and specific molecular fingerprint that bowel cancers leave in the blood.
Early studies have shown a single blood test can detect bowel cancers with the same accuracy as colonoscopy. This year the study will be expanded to recruit patients from hospitals in South Wales and from participating GP surgeries along the M4 corridor, in order to assess the discriminatory power of the blood test to distinguish between bowel cancers at different stages of disease, and from other common gastrointestinal problems that present with similar symptoms. The technology platform will also be expanded to include other hard to detect cancer types such as pancreatic and liver cancers.
Professor Gareth Jenkins, also at Swansea University is working on another blood-based test this time for oesophageal cancer, a cancer type that is steadily on the rise and forecast to replace bowel cancer as the most common cancer related emergency that a GP will encounter in primary care. This test known as the cancer smoke detector test works by detecting mutated proteins (the smoke) expressed on the outside of red blood cells, which betray the presence of cancer (the fire) lurking somewhere in the body.
As these cells often appear in the blood a long time before symptoms appear, there exists a real opportunity to detect cancer in high risk groups a lot earlier than previously possible. During initial stages of development that used samples from over 300 consenting patients the test was sensitive enough to discriminate between patients with confirmed oesophageal cancer, those with Barret’s oesophagus the most common precancerous condition affecting the oesophagus, and those found to be healthy.
Both tests have the potential to transform the main referral pathways for cases of suspected cancer and possibly refine referral to one-stop diagnostic centres being trialled at two centres in Wales. Current pathways are too long and too complicated, and only 1 in 10 patients that enter via the urgent referral pathway will turn out to have cancer. This causes great anxiety in patients, puts a strain on resources, and comes at great expense. It is estimated negative findings from investigative endoscopy of the bowel and oesophagus have an annual global cost of over £3 Billion to health care systems.
With these at a more advanced stage of development than some recent highly publicised news items describing similar tests from other parts of the world, it is wonderful to think that Wales is leading the way in this area. Cancer Research Wales is extremely grateful to the generosity of the people of Wales, whose support ensures that world-class research can take place closer to home.