Early Diagnosis: 10 years on

Sara HiomDirector of Early Diagnosis and Health Professional Engagement

Cancer Research UK 5th Biennial Early Diagnosis Research Conference11th – 13th February 2019Birmingham, UK

Recap from yesterdayMonday 11th FebruaryEarly Career Researchers: Showcase of research into early diagnosis

• Dr Katriina Whitaker and Dr Fiona Reddington (chairs)• Dr Paula Bradley• Dr Robert Kerrison• Dr Cathrine Wildenschild Nielsen• Dr Marije van Melle• Bethany Wickramasinghe• Hanna Skrobanski

Sharing insights: research and initiatives to improve public awareness and drive behaviourchange

• Professor Yoryos Lyratzopoulos (chair)• Carolynn Gildea• Katie Connor• Dr Monica Koo• Natalia Calanzani

Poster viewing and welcome reception

Tuesday 12th FebruaryWelcome: Sara HiomKeynote: Professor Harry De KoningEmerging evidence: a spotlight on lung cancerKeynote: Dr Jem RashbassExploring and using national cancer data for patient gain‘Zombie Apocalypse’Keynote: Sara Hiom, Cancer Research UKKeynote: Professor Robert Steele CBELate breaking showcaseKeynote: Professor Sir Mike Richards CBETargeted breast screening and care: developments and insights to shape the future for patients with breast cancer

Panel debate: accelerating innovation and advancements in researchPanellists including: Professor Gareth Evans, Fiona Walter, Geoffrey Hamilton-Fairley, Professor Stan Kaye, Fiona Reddington

Reflections from day one: Mike Richards and Sara HiomAccelerating the pace of scientific progress through access to data

CRUK funding opportunities and advice: Population research and research careers team

10 Years On: Anniversary Dinner and Awards

Wednesday 13th FebruaryKeynote: Professor Willie Hamilton CBE

Optimising recognition and referral across the patient pathway

Keynote: Cally Palmer CBE

Panel debate: Accelerating shifts in stagePanellists including Professor Tom Crosby OBE, Jane Lyons, Professor Willie Hamilton CBE, Dr Jodie Moffat, Tom Haswell

Working lunch: Spotlight on cancer pathwaysSpeakers include: Professor Tom Crosby OBE, David Fitzgerald, Margaret Kelly

Spotlight: cervical screening Emerging evidence from MDCs in the UK

Using local data to drive progress

Considering the impact of early diagnosis: recurrences and secondary cancers

FIT in symptomatic: emerging evidence and opportunities

Keynote: Mr John Butler

Evidence to make a difference in rare and less common cancers

Housekeeping

Mobile phonesFire drills Eventpro UK

Evaluation forms Presentations Filming

Wifi: BTOpenZonePassword: cruk19

Slido: Download app or sign up at www.sli.do

• Late stage diagnosis is still a problem

• Progress over the last 10 years:- Screening- Awareness & Beliefs- Primary Care- Diagnostic Pathways

Early diagnosis: 10 years on

Late stage diagnosis is still a problem

2009

2011

2015

2017

2013

2019

How can we reduce late stage diagnosis?

Act across the

pathway

Hiom et al. (2015) Diagnosing cancer earlier: reviewing the evidence for improving cancer survival. BJC

The changing focus on early diagnosis in cancer strategies

2007

2008

2011

2015

2016

2017

2019

Cancer Reform Strategy1 for England published. The first to include early diagnosis as a priority

Scotland’s Better Cancer Care Action Plan2 launchedCancer strategy for NorthernIreland (NI) published

Improving Outcomes for Cancer Strategy published in England

Achieving World Class Cancer Outcomes strategy for England3 published

Beating Cancer: Ambition and Action published in ScotlandCancer Delivery Plan for the NHS to 2020 4 published in Wales

The NHS Long Term Planfor England published

1Cancer Reform Strategy, Foreword, Gordon Brown , 2Scotland’s Better Cancer Care Action Plan, 3Achieving World Class Cancer Outcomes, 4Cancer Delivery Plan

“The Scottish Government is committed to an evidence-based approach to screening” 2

“awareness and behaviours of people who might be affected by cancer and among primary care teams; improved

screening uptake and the interface between primary and secondary care; improved access and efficiency of diagnostic

and treatment services” 4

“NHS England should mandate that GPs have direct access to key investigative tests for suspected

cancer…by the end of 2015.” 3

“Early diagnosis is vital if we are to achieve a genuinely world-class cancer service”1

• Late stage diagnosis is still a problem

• Progress over the last 10 years:- Screening- Awareness & Beliefs- Primary Care- Diagnostic Pathways

Early diagnosis: 10 years on

What progress have we made in screeningover the last decade?

2008

2011

2017

2019

Bowel screening established in Northern Ireland

Bowel scope paper shows reduction in bowel cancer incidence and mortalityNational Lung Screening Trial results published

Independent Breast Screening Review published

Bowel scope screening initiated in England

Faecal immunochemical test (FIT) rolled out in ScotlandScreening and inequalities network established in ScotlandWales launch HPV as primary cervical screening testReview of Screening Programmes in ScotlandEngland - Commitment to reduce bowel cancer screening age to 50

2010

2012

2013

2018

Spotlight: Faecal Immunochemical Test

Plans for ‘FIT’, a more sensitive bowel cancer test… will be confirmed. 1

2015

1 Achieving World Class Cancer Outcomes 2 NHSE announcement 3 GOV Wales newsroom 3 sTV News

NHSE2017

The introduction of FIT within the bowel screening programme is

expected to start during 2018/193

2017…new bowel cancer screening test

that will enhance our ability to save lives

2015

Replacement of the gFOBt test with the more sensitive and easier-to-use faecal immunochemical test (FIT) 1

Plans for ‘FIT’, a more sensitive bowel cancer test… will be confirmed2

KW37

Slide 12

KW37 https://phescreening.blog.gov.uk/2016/07/25/were-getting-fit-for-bowel-cancer-screening/ (2016 blog, flagging intro of FIT in England in Spring/Summer 2018)

NSC press release https://www.gov.uk/government/news/uk-nsc-recommendations-include-new-bowel-cancer-screening-testKathryn Whitmore, 11/02/2019

What progress have we made in awareness & beliefs over the last decade?

2008

2019

National Awareness and Early Diagnosis Initiative (NAEDI) launched

Detect Cancer Early (DCE) programme launched in ScotlandFirst all-England Be Clear On Cancer campaign

ICBP awareness and beliefs about cancer paper published

First Be Cancer Aware campaign in Northern IrelandScottish Government/CRUK “wee c” campaign

2012

2013

2015

2016

Lung cancer awareness BCOC campaign in Wales

Awareness and stage shift

What progress have we made in primary care over the last decade?

2008

2019

The CAPER studies published

CRUK Facilitator programme pilotRCGP – CRUK Partnership established

PCTs replaced by CCGs. SCNs established.Cancer Decision Support (CDS) tool pilot

NG12 update – lower threshold for referralICBP Module 3 – publication linking readiness to refer with survival

2012

2013

2015

2009

2016

2018

Scottish cancer referral guidelines review

2011

Improving Cancer Outcomes recommends GP direct access for key test

National Cancer Diagnosis Audit

Spotlight: National Cancer Diagnosis Audit

What progress have we made in diagnostic pathways over the last decade?

2008

2019

First cytosponge trial published

Accelerate, Coordinate, Evaluate (ACE) launched

British Thoracic Society Guidelines for the Investigation and Management of Pulmonary NodulesCRUK Horizon scanning and Scoping the future reports published

NICE DG30 guidance for the use of FIT in symptomatic patients publishedCompletion of ACE Wave 1National Optimal Lung Cancer Pathway (NOLCP) published

2015

Preliminary ACE MDC results publishedRapid cancer diagnostic and assessment pathways published (monitored from 2020)‘Capacity to diagnose?’ CRUK report

2014

2010

2017

2018

2016

CRUK testing times to come reports published

Spotlight on multidisciplinary diagnostic centres (MDCs)

Diagnosing cancer: a needle in a haystack

Routes to diagnosis, England, 2016

0

20

40

60

80

100

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

I II III IV I II III IV I II III IV I II III IV I II III IV

1-ye

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%)

Num

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osed

per

yea

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Incidence by stage (2016) overlaid with 1- year survival by stage (2015, followed up to 2016)

Number of cases 1yr survivalBreast Prostate Lung Bowel Melanoma

Stage:

Late stage diagnosis is still a problem

We need

Thank you!

#CRUK10yearsofearlydiagnosis

Cancer Research UK 5th Biennial Early Diagnosis Research Conference11th – 13th February 2019Birmingham, UK