About a quarter of all cancers can be prevented, but for those who do develop cancer, an early diagnosis still offers the best chance of cure. Even for those with advanced disease, earlier diagnosis provides the opportunity to more effectively employ disease-modifying treatments and to put in place symptom management approaches. With Scotland’s cancer survival deficit occurring primarily in the first year after diagnosis, late presentation and advanced stage at treatment are thought to be important contributors to the current position.
The Detect Cancer Early Programme is regularly challenged about its impact on survival, given the lead time bias arguments and international data quality comparisons. But there are potentially other benefits from the programme – a more health literate general population, improved awareness of cancer presentations and screening programmes, better data on cancer staging, reduced emergency department presentations and lengths of stay in hospital, collaborative working between public health, primary care and the acute sector and improved patient experience with reduced variation in referral practice.
Working in the health sector, it is easy to forget that warning signs and symptoms are not always second nature to the general population – several studies have demonstrated poor levels of cancer awareness. Nor are health matters always uppermost on the agenda when faced with other life pressures particularly in the socio-economically deprived.
The DCE Programme aims to tackle stigma and perceptions about cancer ‘fate’ and, if successful, along with promoting awareness of screening and warning signs and symptoms, will lead to more people making contact with both screening and symptomatic services. If these contacts result in a ‘near miss’ event (cancer ruled out despite worrying symptoms), then there is an ideal opportunity to deliver clear, concise and simple messages about lifestyle risk factors.
Although the evidence on lifestyle and cancer risk are clear, our messages about preventative action may be less clear – if health professionals are confused about what to communicate it is unsurprising that the general population find the advice muddled. We need to make preventative messages clear for those working in the health sector so that the opportunities delivered by the increased contact with the NHS from Detect Cancer Early are used to best effect to promote cancer prevention awareness and action. The conversations might feel uncomfortable at first, but the more they are delivered, the easier it becomes and the more they are heard, the more they are likely to be acted upon.
The Detect Cancer Early Programme is not the panacea for improving Scotland’s survival deficit. This objective will only be achieved by a combination of approaches –addressing co-morbidities, general physical and emotional well-being, access to treatments and quality of care at and around treatment delivery – but it is clear that primary and secondary cancer prevention measures will contribute to general health and well-being that will in turn help achieve long term survival benefit.
David Linden, DCE Programme Director