Effective cancer screening services are essential to providing patients with a better chance of survival, as early diagnosis is linked with a greater potential for treatment success. Yet uptake of cervical screening in the UK has fallen to the lowest level since records began 21 years ago, while that of mammograms has also dropped to a decade low.
Sir Mike Richards’ Review of National Adult Screening Programmes, which looked at NHS screening programmes for abdominal aortic aneurysm, bowel cancer, breast cancer, cervical cancer and diabetic eye, shows that the current system is failing to reach its potential. It is clear that reform – including embracing new innovation – is urgently needed if we are to accelerate early diagnosis and ultimately improve cancer outcomes for patients.
Breast cancer remains a major disease in the UK, with over 55,000 new cases and around 11,400 deaths every year. While breast cancer is the most common cancer in the UK, with a new diagnosis every 10 minutes, more than 20% of cases are preventable. It remains the second most common cause of cancer death amongst women in the UK, and yet screening rates have fallen significantly in recent years, and more than one in ten breast cancer cases are diagnosed late in England, Scotland and Northern Ireland.
Missing targets
The NHS Breast Screening Programme (NHSBSP) has been critical to improving cancer survival rates in England by driving earlier diagnosis and ultimately preventing about 1,300 deaths a year. But this number could be even higher. Only about 70% of eligible women responded to their screening invitation last year, leaving more than 750,000 eligible women unchecked. The National Audit Office (NAO) also found that the NHS target for cancer screening – 80% of women eligible for screening should be screened within the previous 36 months – was only met in one of 207 Clinical Commissioning Groups in 2017/18, with 65 CCGs reporting coverage below 70%.
One of the most effective solutions to falling rates of screening, as highlighted by the Review, is to upgrade ‘woefully out-of-date’ IT systems and capitalise on the best available technology, which requires increased uptake of innovation across the NHS. New technology like contrast imaging provides faster and more accurate results, particularly for women with dense breast tissue, who are known to have a greater risk of developing breast cancer. This technology can reduce waiting times for traditional MRI scans, supporting the workforce through providing more accurate results earlier and ultimately saving lives.
There are already some of exciting examples of how the NHS is starting to embrace the life-saving potential of new technologies. Most recently, in the absence of a national screening programme for lung cancer, the NHS has begun piloting Lung Health Checks in some areas of England, where current and former smokers are assessed for their risk of lung cancer and those at increased risk are offered low-dose CT scans. If the pilots succeed, it is intended that the programme will be rolled out nationally.
Although this development is a welcome step forward for early diagnosis and patient outcomes, there is an opportunity to do so much more. The Review states that ‘high priority should be given to spreading the implementation of evidence-based initiatives to increase uptake’. Moving forward, we encourage NHS England to create a forum for engaging with industry to explore the use of innovative technology – such as mobile screening units and integrated artificial intelligence (AI) systems in screening programmes like the Lung Health Checks – to help deliver Sir Mike’s call for better services in local communities.
The patient perspective
New technologies also have the potential to improve patient experience. The Review highlights that the patient perspective should be central to the evaluation and commissioning process for all screening programmes. However, an important aspect of this, which is not addressed by the Review, is the impact of pain during breast screening. Pain is a key reason that women do not re-attend screenings. Of those women who previously attended a screening appointment, more than 10% failed to do so in 2017/18, resulting in an estimated 1,245 missed breast cancer diagnoses every year.
Between 25% and 46% of women who fail to re-attend screenings cite pain as the reason, yet the evaluation process for technology does not prioritise this important factor. So, we need to reassess how new technology is evaluated to make sure patients have access to the best screening equipment available for their needs.
The way we diagnose and treat cancer is constantly evolving and the possibilities for the future of screening programmes are vast. Sir Mike’s Review has heavily focused on the exciting opportunities of future technologies, such as AI. AI holds the potential to not only facilitate clinical decision-making and improve early diagnosis but actually shift these decisions closer to primary care so GPs are catching cancer earlier and hospitals can focus on treatment. This has the potential to dramatically reduce workforce pressures and hospital waiting times. To capitalise on the potential of new technologies, the NHS must prepare by involving clinicians, patients and industry in understanding how best to adopt these innovations.
While the Review highlights areas for improvement of screening services, it is important to remember that NHSBSP has saved thousands of lives since its launch in 1988, and there is a range of excellent work being done both within the programme and across the NHS to improve cancer outcomes. The successes of the programme so far have been based on fantastic work driven by the NHS and Public Health England, but also with support from healthcare charities, industry and patients. Working collaboratively across the healthcare system to improve public knowledge and awareness of the importance of screening remains key and must be at the core of any system reform. As such, Fujifilm has been working closely on a number of largescale projects with Coppafeel! to help women feel more confident about speaking to their doctor when something doesn’t feel right, removing stigma and increasing understanding around self-checking for breast cancer.
We hope that the findings of this Review help facilitate a system that increasingly focuses on the needs of patients and fosters innovation, now and in the future, to support clinicians and deliver faster results, and fully support its recommendation that ‘urgent change is needed if NHS screening programmes are to have any chance of realising’ the potential of new innovations like genomics and AI, which can enhance screening programmes and release workforce capacity.
Increasing early detection was put at the heart of the NHS Long Term Plan, along with a commitment to upgrade services and make sure patients benefit from new technologies and treatments. Digital innovations hold the key to improving cancer survival rates and the implementation of these important recommendations could foster real systemic change, marking a major step towards improving cancer services and the early detection of disease.
Adrian Waller is general manager of Fujifilm Medical Systems UK
