NICE has published new guidance for the diagnosis of cancer, which it hopes will save thousands of lives every year.
NICE estimates that nearly a quarter of all deaths can be attributed to cancer. Many of these will be terminal cancer cases due to late diagnosis, yet the organisation believes 5,000 deaths could be avoided if a diagnosis is made at an earlier stage.
As a result, NICE has updated and redesigned its guideline to support GPs to recognise the signs and symptoms of 37 different cancers and refer people for the right tests faster. In many cases, symptoms may be non-specific and signs of cancer may also not be clear or obvious.
The new guidelines use a new approach – focusing on the symptoms that a patient might experience and go to their doctor with – to make its recommendations easier for GPs to use.
In addition, the guidelines set out clear tables linking signs and symptoms to possible cancers and include simple recommendations about which tests to perform and the type of referral to specialist services that should be made.
NICE says this will make it easier for GPs to think about the possibility of cancer sooner and refer people for tests quicker. This in turn will mean more people receive an early diagnosis and subsequently, more cancers could be cured.
More than 300,000 new cancers are diagnosed annually in the UK, across more than 200 cancer types. A full-time GP will have 6,000-8,000 appointments every year, but only about 10 minutes per appointment to pick out warning signs that could be cancer, but equally may be a symptom of a less serious condition, hence the need for symptoms-led, early diagnosis.
The updated guidelines are organised by symptoms that should prompt a 2-week wait referral, further investigation in primary care, and safety-netting in primary care. They cover:
- Abdominal symptoms
- Gynaecological symptoms
- Lumps or masses
- Neurological symptoms
- Respiratory symptoms
- Skeletal symptoms
- Skin or surface symptoms
- Urological symptoms
- Non-specific features of cancer
- Primary care investigations.
Professor Mark Baker, clinical practice director at NICE, said: “The best way to successfully treat cancer is to make an early diagnosis. The sooner the disease is identified, the more likely treatment is to be effective. Earlier diagnoses have the potential to save thousands of lives each year.
“This guideline uniquely amongst guidelines of this type presents the evidence on the way that patients present to their GPs. It reflects real life and we expect it to have a major impact on the success rate for cancer in England.”
"No GP wants to miss a cancer diagnosis"
Dr Steve Hajioff, a Director of public health, who chaired the independent group of experts that developed the guidance for NICE, said: “Traditionally, cancer referral guidelines have presented their evidence on a cancer-by-cancer basis because that’s the way the research is done. However, that does make them very difficult to use if someone has a symptom that’s related to multiple cancers.
“A symptom-based approach, in effect, takes a symptom, for example abdominal pain, or a set of symptoms, and brings them together to identify the potential cancers that it could be. The purpose of this approach is to make it easier to use by primary care clinicians in a busy consulting room so that they don’t have to wade through documents. They can look very quickly at the information to help them make an appropriate decision and so potentially fewer things are missed.
Professor Willie Hamilton, a GP and Professor of Primary Care Diagnostics at the University of Exeter who helped to develop the updated guideline, said: “This guideline is about getting the right patients to the right tests at the right time.
“Traditionally, GPs have always had some tests available such as blood tests, X-rays and some scans. This guidance expands this by bringing some tests that have been traditionally thought to be hospital tests under the wing of GPs. It will open the door for smarter testing so that people with cancer will receive their diagnosis much earlier. There is no doubt in my mind that this guideline will help to save lives.”
Sara Hiom, Cancer Research UK’s Director of Early Diagnosis, added: “These new guidelines for suspected cancers will give GPs more freedom to quickly refer patients with worrying symptoms – crucial for a disease that can be hard for GPs to spot in primary care. This will mean diagnosing more cancers earlier, at a stage when treatment is most likely to be effective, better for patients and ultimately increasing survival.”