Health
Balancing tried-and-tested against future innovation – a strategy for boosting earlier cancer diagnosis – Cancer Research UK
This has long been recognised – a previous Government target aimed to diagnose 75% of cancers at stages I and II by 2028. But progress has been slow.
Will things be different this time? We think that relies on two things: an ambitious plan and a realistic path to delivery.
The ambition is clear.
The Plan commits to not one but four metrics that capture different aspects of the earlier diagnosis challenge. Crucially, this includes the aim of increasing the proportion of cancers diagnosed at stage I and II by 20 percentage points by 2035.
The route to delivery is more complicated.
On the one hand, there’s a pressing need for new tools and new thinking – in other words, the transformative potential of innovation. So it’s welcome that the Plan embraces opportunities to explore new technologies and ideas around earlier diagnosis.
On the other – as the Plan’s authors acknowledge – many promising earlier diagnosis innovations are still largely unproven.
This means that if it’s serious about change, the government must also put real weight behind proven approaches that can reliably unlock improvements – like making sure that people with suspicious symptoms don’t delay getting them checked, or helping GPs identify which people need further investigations.
Striking the right balance between these two imperatives – driving forward promising innovation, whilst capitalising on less-exciting but better-evidenced opportunities – is where the 2026 Plan is less certain.
The Plan contrasts the current model of care, which it calls ‘outdated’ and ‘reactive’, with a ‘big leap’ in technology that enables a ‘proactive’ approach to diagnosing cancers. The resulting effect is to downplay the strategic importance of getting the most value from ‘tried-and-tested’ approaches, in favour of a future vision of ‘proactive care’ based on as yet unproven innovation.
This is a trap that the Government must not fall into as it moves towards delivery.
Improving screening for cancers without symptoms
‘Proactive testing’ for cancer is not an entirely new idea. It’s the principle behind cancer screening, which offers tests to eligible people when they don’t have any symptoms. The UK’s three evidence based screening programmes (for breast, bowel and cervical cancer) are effective ways of reducing late cancer diagnoses, with potential harms minimised.
So it’s good to see practical, evidence-based commitments to enhance these programmes, like addressing inequalities in participation. The Plan also promises to fully roll out lung cancer screening for people with a smoking history by 2030. This is essential – we estimate that this could avoid around 1,500 deaths a year in England by shifting diagnoses from late to early stage.
The Plan also focuses on two promising areas of screening innovation.
Firstly, it envisions far greater use of ‘risk-based’ approaches that tailor the screening people receive based on things like their genetics.
And secondly, it highlights the potential of multi-cancer early detection (MCED) tests, which – if proven effective – could lead to transformational opportunities to detect a wider range of cancers with just one test.
But although early steps are underway, there’s a long way to go before the future role of these innovations is clear. While we wait for research to deliver answers, the Government must ensure that it puts just as much energy into the crucial – if less eye-catching – work that will ensure that existing screening programmes deliver maximum benefit.
Being more ‘proactive’ in diagnosing symptomatic cancers
Screening is only part of the picture. Far more cancers are found when people have tests after noticing a symptom or change in their body – often via their GP. Improving the way the healthcare system diagnoses these cancers could make a big difference.
Here too, the Plan embraces a more innovative ‘proactive’ approach, including a concept it calls ‘case finding’. This term covers a range of activity, including contacting people who have symptoms linked to cancer to offer them tests.
‘Case finding’ programmes are already getting going in the NHS – for example, identifying people with diabetes and other symptoms that might indicate pancreatic cancer. The Plan anticipates developing similar schemes for other cancers. But it is essential that it keeps its promise to ‘assess the evidence on extending this approach’ before doing so. We don’t yet know which ‘case finding’ approaches are effective, and some may have harms that outweigh any benefits.
Doing ‘what works’ – a missed opportunity?
Given the Plan’s emphasis on innovative ‘proactive’ services, it’s perhaps unsurprising that it seems less ambitious when it comes to improving established ways of diagnosing symptomatic cancers. But, in our view, this represents an under-exploited opportunity to reduce late-stage cancers.
Take the Plan’s approach to encouraging people to seek help for suspicious symptoms. Over the years, our work, and that of others, has built up a detailed understanding of prospects for improvement in this area. But although the Plan promises some action, like local symptom awareness campaigns, it is relatively light on promises to put this learning into practice at scale.
Similarly, the Plan commits to welcome actions to support GPs, like expanding the use of tools that help identify which patients to refer for tests. But this would have been more powerful if accompanied by a clear plan to support innovation in this area (alongside other areas like genomics or wearables).
This may reflect the greater appeal of strategies that rely less on under-pressure GP services, and the Plan does highlight work exploring alternative options like using NHS 111 services.
Such pressures are real, and deserve proper consideration.
But so too does the fact that, over the next ten years, going to a GP with symptoms is still likely to be how most people’s cancer journeys will start. As we move towards the promised 3-year refresh of the Plan, greater prominence must be given to the many opportunities in this area.
A delicate balance
The Government has set itself a bold ambition on earlier cancer diagnosis, with important commitments to essential actions.
Whether or not the overall strategy is equal to the ambition now rests on the approach to delivery. The Government and the NHS must delicately balance two key challenges: harnessing the incredible potential of future innovation, while also realising the benefits of proven interventions that are already within reach.
With the right determination, funding and support for delivery – across both these areas – this Plan could deliver a real shift towards earlier diagnosis and transform the prospects for cancer outcomes in the future.
