Grant Jordan: Cancer in Scotland’s faulty diagnosis


Professor Grant Jordan takes a look at the Scottish Government's strategy for dealing with cancer diagnosis and treatment

AS cabinet secretary for health and wellbeing, Nicola Sturgeon formally launched the Detect Cancer Early (DCE) programme in February 2012. The project covered breast, colorectal and lung cancers, and had a legitimate theory of causation. 

It was based on the (then) uncontested fact that early diagnosis increases the opportunity for successful treatment, and that the earlier presentation of patients with symptoms meant treatments could start earlier. The new Beating Cancer: Ambition and Action policy statement from the government as recently as March 2016 implies that the DCE campaign was a success. 

It claimed that "this ambitious programme aims to improve one-year and five-year survival rates … by actively addressing diagnoses and treatment at an early stage". Detect Cancer Early had clear goals – "to increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25 per cent by 2014/2015". 

This was optimistic, but it could be evaluated as it had built a wonderful database – though cracks are appearing as some authorities are belatedly trying to alter their submissions. Nonetheless, the dataset now allows the sombre conclusion that, well-intentioned though it was, it is not working as hoped. 

The latest DCE figure (July 2016) repeated the narrative of underperformance from the previous years.

The government had set a target of a 25 per cent increase over the baseline figures by the end of 2015, but a good idea simply did not work out. The issue is a reluctance to concede that the impact was a dismal failure by its own very explicit standards. 

The implication is therefore that a new policy is urgently required. The cancer charities that dutifully lined up behind the government at the launch need to show some independent thinking.

Current health secretary Shona Robison was quoted on the BBC website saying: "The figures released today show that over 25 per cent of all breast, lung and bowel cancers diagnosed in Scotland during 2014 and 2015 were detected at 'stage one' – an increase of eight per cent in the last five years." 

The actual improvement was from 23.2 per cent to 25.1 per cent. The increase is eight per cent of the base figure, but her unadorned version perhaps implies 17 per cent to 25 per cent. Moreover, at least some of the increase in stage 1, and other stages, is most likely due to better recording of the data and the reduction of the undisaggregated 'not known' category.

Squeezing the 'unknowns' meant there were more than 800 cases going into boosting the classified categories. The report acknowledged that Scotland as a whole, and six of the 11 individual mainland NHS Boards, have shown an increase in stage 1 diagnosis, but for NHS Forth Valley there has been no change while NHS Grampian, NHS Highland, NHS Borders and NHS Dumfries and Galloway have shown a decrease, despite increased funding.

The DCE campaign was a realistic diagnosis that was unfortunately undelivered. The mature response is to look at new ideas, not to twist and turn to defend the project. It seems an eminently suitable target for the health and sports committee. It could, for a start, try to work out what is new money in the Beating Cancer agenda and what is a continuation of existing policy or the funds to cover previously announced changes. 

There are great things happening in cancer treatment, but diagnosis is very imperfect. The current government obsession is that the variability is a social class matter, but why then is NHS Grampian so consistently below average? 

There are shocking disparities in the survivability of some cancers such as breast and malignant melanoma and lung, brain and pancreas. What is the plan to identify non-smoking lung cancer patients? A rote conclusion in the surgery that a cough is "probably asthma" does not match the 'world class ambitions' embedded in minister- speak.

Are there funds to allow diagnostic scanning? A male with lung cancer has a 9.5 per cent probability of surviving five years. A breast cancer patient has an 82.8 per cent probability (Cancer in Scotland, Information Services Division, November 2015, p17). 

Politically there isn't even recognition of an issue, far less resolution. The car sticker should be 'Diagnose Late: Die Early'. It is the Scottish way.

Picture courtesy of Alex Proimos

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