Cancer screening ‘must not get lost’ under other NHS pressures

Cancer screening must not get lost underneath the pile of other pressures facing the NHS, leading health experts have warned.

The King’s Fund pointed to large variations across England in how long it takes people to get the results of their tests, while there is patchy access to screening in some areas.

The impact of the Covid pandemic is still being felt across the country, with the proportion of cancers diagnosed at an early stage still not reaching 60%, the think tank said.

Saoirse Mallorie, senior analyst at the King’s Fund, said: “Alongside addressing ambulance pressures, workforce shortages, and waiting lists, it is important that prevention is a priority of the new Government.

“Prevention is a key way of keeping people out of hospital and identifying health conditions before they become more difficult to treat. This is particularly true when it comes to cancer screenings.”

There are three main types of cancer screening on the NHS: bowel cancer testing which is offered to people aged 58 to 74, breast cancer screening every three years for women aged 50 to 70, and cervical cancer screening, which is offered to women aged 25 to 49 every three years and those aged 50 to 64 every five years.

NHS data analysed by the King’s Fund shows a drop in breast and cervical screening rates, particularly for breast cancer.

During 2020 to 2021, some 1.19 million women were screened for breast cancer, a 44% drop on the previous year, the most recent data shows.

Meanwhile, some 70.2% of eligible women aged 25 to 64 were adequately screened for cervical cancer, down from 72.2% the year before.

The fall in breast and cervical screening in 2020-21 led to a significant drop in the number of cancers diagnosed that year.

Analysis by the King’s Fund shows a fall in cancers diagnosed at an early stage, with the percentage of cancers diagnosed at stages 1 or 2 dropping from 57% in March 2020 to 48% in May that year.

The NHS has previously committed to improving cancer survival, partly by increasing the proportion of cancers diagnosed early from 50% to 75% by 2028.

Figures show that the early diagnosis rate is currently 57% (May 2022), prompting the King’s Fund to warn that “there is substantial progress to be made”.

The most recent data also shows that once people attend screening, there are large unexplained variations in how quickly results are processed.

Some 67% of cervical screening results were received within two weeks in 2020-21 in England, but this varied significantly from 91% in the North West to 23% in the East Midlands.

Across England, 11% of results take over three weeks, but that varies from 1% in the East of England to 35% in the East Midlands.

Ms Mallorie suggested lessons could be learned from the Covid vaccine rollout on how to reach under-represented groups, such as mapping where people have not been screened and doing outreach work to overcome hesitancy or improve access to tests.

She added: “Patients are seeing variations in how quickly they receive their test results after a screening, both by type of cancer and geographically.

“Reasons behind this might include whether a region is rural or urban, variations in levels of demand, whether there is the right workforce and resource to turn results around quickly, and inequalities in access.”

However, the King’s Fund was keen to point out that it is not all bad news for screening programmes.

The uptake for bowel screening has increased consistently over the past decade, and the publicity created by Dame Deborah James, who died from the disease in June, may improve this further.

Disruption caused by Covid has also lessened, which could improve uptake rates.