Positive Health Online

Thanks to a number of innovation schemes being trialed across the UK, we could be one step closer to catching cancer in the earlier stages. Scaling up an innovative scheme to catch lung cancer early, plus a more sensitive test for bowel cancer and improved diagnosis of prostate cancer could together save thousands of lives each year.

The Innovative Diagnosis of Early Lung Cancer

Simon Stevens, the NHS England Chief Executive, reported the success of a pilot scheme run in Manchester to boost the early diagnosis of lung cancer. As with most diseases, the earlier it is detected, the more effectively it can be treated. Funded by Macmillan Cancer Support and the Manchester Clinical Commissioning Groups, the pilot scheme was devised by the University Hospital of South Manchester NHS Foundation Trust and MCIP in partnership with GPs, Manchester City Council, Macmillan and Manchester Health and Carel Commissioning. The Manchester scheme used mobile scanners which were taken to busy areas such as shopping centres in three deprived areas of the city, where lung cancer is more prevalent. Scans pick up one cancer for every 33 patients scanned over the course of a year. Of these, 80% were early stage one and two diagnoses and as a result, nine out every 10 people with lung cancer were able to be offered potentially curative treatment. This showed a significant breakthrough - less than 20% of patients diagnosed through usual methods were considered curable.

In addition to the mobile scanner checks, they offered smokers and ex-smokers free health checks and on-the-spot scans. More than 2,500 people with a smoking history underwent health checks - half of these were then offered immediate CT scans that led to 46 cancers detected in 42 people. That’s one lung cancer diagnosis on every scanning day of the project! The success of the pilot programme became apparent when figures revealed that the pilot quadrupled the early diagnosis rates for lung cancer in Manchester, and the outlook is improving for those receiving an early diagnosis. Latest medical reports show that more people with lung cancer are having successful surgery and living longer.

Following the success of the pilot, it is being used across the North of Manchester entirely - an area which has the highest number of lung cancer deaths among the under-75s in England. In addition, NHS England is funding scanners in other areas as part of a national programme to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care.

Sensitive Testing for Bowel Cancer

Simon Stevens also went on to confirm plans for more sensitive testing for bowel cancer. Referred to as ‘FIT’ -  Faecal Immunochemical Test - the new sensitive test could see as many as 1,500 more cancers caught earlier every year. ‘FIT’ is an easy-to-use home testing kit which predicts bowel cancer. Following the introduction of the home test, almost a third-of-a-million more people are expected to complete screening. The sensitivity level of the initial home test determines who should go on for further cancer testing.

Intended for use by people who have no signs or symptoms that suggest bowel cancer, the scheme is already in play in Scotland, with England planning to follow suit in spring/summer 2018, and then Wales in early 2019. The test replaces gFOBt testing as FIT has a reported higher uptake rate compared to the gFOBt. In the Scotland screening, uptake was up 58.7% for the FIT screening, significantly higher than the 53.9% uptake for gFOBt. Similar results were revealed for the pilot that was carried out in two of the five English hubs too.

It is predicted that the test will encourage 200,000 more people to take part in bowel cancer screening - this is because the test is easier to use, more reliable, sensitive to a smaller amount blood meaning it can detect cancer at an earlier stage, or even re-cancer lesions. The screening can be carried out with just one stool sample, as opposed to two samples from three motions needed in other testing.  In the 2014 trial, the new screening also increased uptake in groups with low participation rates, such as men, ethnic minority populations, and people in more deprived areas. Furthermore, since the screening first began in 2006, the NHS BCSP has sent out more than 30 million invitations to take part in the screening, and as a result has detected and diagnosed 25,528 cancers!

Improved Prognosis of Prostate Cancer

Thirdly, another pilot programme is improving the efficiency of detecting prostate cancer using high-definition Magnetic Resonance Imaging (MRI) scans. Results show that MRI is performing better than prostate-specific antigen (PSA) testing in diagnosing prostate cancer and predicting the aggressiveness of the disease. It has reduced the average time for confirmed diagnosis to just eight days and the time from referral to beginning treatment to 20 days. Prostate cancer is the most common cancer in men in the UK, with more than 40,000 new cases diagnosed each year.

Thanks to public donations, Prostate Cancer UK was able to fund the pilot project back in 2010. As a result of the pilot, medical professionals were able to announce the mpMRI breakthrough. Researchers announced that a more accurate form of MRI - known as mpMRI - can improve detection of aggressive cancers while reducing the number of unnecessary biopsies for men.

The new process combines several medical processes into one day to make the testing more efficient for both the medical team and patient. The patient receives an MRI scan and report, a clinical review and, if necessary, a targeted biopsy all on the same day. It is also more accurate, with studies suggesting that the new approach almost doubles the chance of finding life-threatening prostate cancers. Patients who receive an MRI scan which indicates nothing suspicious could be safely discharged back to their GP without undergoing an invasive biopsy.

The success of the first study provided evidence to secure £2 million in government funding to carry on the trials for ‘PROMIS’. The new model is being piloted by three NHS Trusts in London, working closely with Prostate Cancer UK and others to develop a set of standards for the new model. Again, it could be rolled out to other areas in the future, with NHS England now committing to expanded cancer screening to more than four million people in 2018 - with researchers expecting to find that the new process can completely transform the diagnosis, treatment and prevention of prostate cancer.

Speaking about these latest advances, Stevens said: “NHS cancer care is the best it’s ever been, with cancer survival increasing every year. Over the next 18 months, the NHS will be rolling out new mobile scanners and home screening kits to detect cancers earlier, when they can be treated best.”

“The introduction of the FIT bowel cancer screening test is a major weapon in our armoury - potentially diagnosing up to 1,500 more people a year and saving lives”.

Sources

https://www.mhcc.nhs.uk/news/north-manchester-pilot-quadrupling-lung-cancer-early-diagnosis-rates/

http://www.cancerresearchuk.org/health-professional/screening/bowel-screening-evidence-and-resources/faecal-immunochemical-test-fit#FIT4

https://phescreening.blog.gov.uk/2016/07/25/were-getting-fit-for-bowel-cancer-screening/

https://www.medpagetoday.com/clinical-context/prostatecancer/59554