The NHS has committed to diagnosing more cancers earlier, giving patients faster access to potentially life-saving treatments. Its new 10-year plan sets out an ambition that by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients.
Achieving this would mean that, from 2028, 55,000 more people each year will survive their cancer for at least five years after diagnosis.
The government plans to improve public awareness of cancer symptoms and lower the threshold for referral by GPs to cancer specialists, but a big part of its ambition is overhauling the current cancer screening programmes.
So, what’s changing and how do we access the new and (hopefully improved) services?
Cervical Screening
From April 2019 a new cervical cancer screening programme will be introduced, combining the traditional smear test with HPV testing.
The traditional smear test involves taking cells from the cervix and testing these for abnormalities. In recent years scientists have developed the HPV test, which enables them to test these samples for high-risk types of HPV, the infection which sometimes develops into cervical cancer. More than 99% of cervical cancers are caused by HPV.
In some areas of England, a test for HPV is the first test on the screening sample and this is called primary HPV screening. Under the new plan, primary HPV testing will be the routine way to screen for cervical cancer across the country. If HPV is found in your sample, you’ll be referred for further testing and in theory, have access to treatment faster.
The introduction of primary HPV testing for cervical cancer will see more than three million women a year tested and could prevent around 600 cancers a year, according to the NHS.
As with the previous cervical screening programme, women over the age of 25 will receive a written invitation for screening every three years. Trans men who still have a cervix and are still registered as female with a GP will also be invited for cervical screening. Trans men who are registered as male will need to let a GP or practice nurse know so they can organise the test.
Bowel Cancer Screening
Although the majority of bowel cancer patients are over the age of 60, the starting age for bowel cancer screening will be lowered from 60 to 50 under the news plans. The method for testing is also changing.
Since the Bowel Cancer Screening Programme was introduced in 2006, the primary method for testing the disease has been a stool test, where faeces is tested for blood. The current test requires three separate stool samples to be collected, and if doctors require repeat tests, sometimes as many as nine are needed.
In 2018, a new method called the Faecal Immunochemical Test (FIT) was rolled out in some parts of the country and this will be extended under the new plan. The new test only requires one sample to be collected.
“This sample is collected into a test tube which is sent through the post to the bowel cancer screening Hub (an NHS laboratory),” Bowel Cancer UK explains.
“As well as being a lot simpler and more pleasant to use, FIT is also a more sophisticated and reliable test that uses an antibody to bind to any blood present so we know how much blood is present in the sample.”
In trials FIT has been shown to improve take up rates by 7%, including among groups with low participation rates such as men, people from ethnic minority backgrounds and people in more deprived areas.
If you’re registered with a GP and live in an area where the test is available, you should automatically be sent an invitation. If you do not receive a letter, you can speak to your GP or call the free bowel cancer screening helpline on 0800 707 60 60 to check if testing is available in your area.
Lung Cancer Screening
A breath test piloted in Liverpool and Manchester to assess lung cancer risk will be extended across England from 2019 under the new plans.
The screening involves a breath test and having a discussion with a medic to assess your individual lung cancer risk. Any patient assessed as being at high risk of lung cancer will have an immediate low-dose CT scan, which can detect abnormalities that may be signs of lung cancer.
During the Manchester trial, 65% of lung cancers were diagnosed at stage 1 and 13% at stage 4, compared to 18% at stage 1 and 48% at stage 4 before the trial.
Over the next two years, the NHS has committed to extending the lung health checks and deploying more mobile lung CT scanners in supermarket car parks, starting in parts of the country with the lowest lung cancer survival rates.
The NHS has yet to announce the locations of new units, so keep your eyes peeled in your local area and be sure to ask your GP for updates.
Changes To All Other Screening Programmes
After a series of screening scandals, including a breast cancer screening error and the recent cervical screening error, NHS England has asked oncologist Sir Mike Richards to lead a review of the current cancer screening programmes and diagnostic capacity. This will make initial recommendations by Easter 2019 and be finalised in the summer to further improve the delivery of the screening programmes, increase uptake and ensure lessons are learned from the recent failures.
The plan also commits to introducing a new faster diagnosis standard from 2020 to ensure most patients receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening. For people diagnosed with cancer, it will mean they can begin their treatment earlier. For those who aren’t, this will put their minds at rest more quickly.