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 to find the most effective ways to diagnose more people, more efficiently and at the earliest point possible.
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 many other nations with similar healthcare systems, with late diagnosis thought to be a major reason.
Recent data published by the Wales Cancer Intelligence and Surveillance Unit show that more than half of Wales’ most common cancers are unfortunately diagnosed at a late stage, when they are more difficult to treat, manage and cure.
Many complex issues contribute to late diagnosis, ranging from patients who may be unaware of cancer symptoms, to someone who delays visiting their GP due to not wanting to trouble their doctor. Similarly, due to the overlap of cancer symptoms with many other prevalent, 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 significant role that primary care has in cancer diagnosis, and highlights the crucial need for research into early diagnosis.
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 current barriers to early cancer diagnosis in primary care.
This ‘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. The study hopes to design interventional tools that will better help GPs diagnose cancer in these areas, while adding to the evidence base.
In other areas Cancer Research Wales, is funding the development of much needed blood tests to 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.
One test, developed by Professor Dean Harris and Professor Peter Dunston at Swansea University, uses a laser 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 of this kind can detect bowel cancers with accuracy close to that of colonoscopy. With further funding 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 in distinguishing 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 cancer.
Professor Gareth Jenkins, also at Swansea University, is working on another blood-based test, this time for oesophageal cancer. 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 reveal the presence of cancer – ‘the fire’, existing somewhere in the body.
Both these tests, in addition to other research into similar diagnosis tests, have the amazing potential to transform the main referral pathways for cases of suspected cancer and possibly refine cancer referrals to one-stop diagnostic centres, which are currently being trialled at two centres right now in Wales.
Current pathways in Wales and nationwide, are too long and 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 that negative findings from investigative endoscopy of the bowel and oesophagus have an annual global cost of over £3 Billion to health care systems; suggesting that research into early diagnosis is now more vital than ever in the fight against cancer. The early diagnosis research projects that Cancer Research Wales lead seek to streamline the referral process; saving unnecessary worry, resources, time, money and ultimately lives.
Wales is leading the way in early diagnosis research, with these types of tests being at a more advanced stage of development than similar tests also being developed globally.
Cancer Research Wales is extremely grateful to the generosity of the people of Wales, whose continued support ensures that world-class research can take place closer to home. Their support helps to not only fund promising early diagnosis research projects and tests, but also enables them to continue to be a major force in the discovery of better treatments and progress towards cures.