Concern over late-stage diagnosis of cancer

Progress in ovarian cancer care has “completely stalled”, a charity has warned.

It comes as a new audit revealed that about four in ten women (41%) in England and Wales were only diagnosed after their symptoms were so severe that they sought emergency care in hospital.

The national ovarian cancer audit also highlighted how significant numbers of women with the disease are only diagnosed once their disease had spread to another part of the body – making it harder to treat.

In England, some 32% of cases were diagnosed at this stage in 2022.

In Wales, some 24% of cases were only diagnosed when the cancer was so advanced that it had spread elsewhere.

Ovarian Cancer Action said there are a number of factors at play, including women having symptoms dismissed or misdiagnosed, and low awareness of symptoms.

“Overall, progress has completely stalled,” said Cary Wakefield, chief executive of Ovarian Cancer Action.

“Nearly half of women with ovarian cancer are only diagnosed once their symptoms are so severe they end up in A&E.

“This is a failure of awareness, of diagnosis, and of the system. And it’s costing lives.”

Dr Nikita Kanani, a GP and former top NHS official, said: “For too long, women’s symptoms have been dismissed, leaving them to reach crisis point before getting answers.

“These figures show why we must shift from reactive care to proactive listening and early diagnosis. Women deserve to be heard the first time they raise concerns — not once they’re in A&E.”

Many women are told their symptoms are due to irritable bowel syndrome, the menopause or stress, the charity said.

Ovarian Cancer Action is urging women to use its online symptom checker which is designed to spot signs of ovarian cancer early on.

It comes as a number of other cancer audits were also published, including:

– The audit of those diagnosed with oesophageal or gastric cancer in England and Wales found 21% of patients in England and 14% of patients in Wales are diagnosed after a trip to A&E. Some 38% of patients in England are diagnosed at stage four – when the cancer has spread; compared to 32% in Wales.

– The majority of pancreatic cancer patients are diagnosed at a late stage – with 62% of patients in England and 65% of patients in Wales diagnosed at stage four, according to the pancreatic cancer unit. Survival rates are particularly poor for this type of cancer – some 22% do not survive for 30 days after diagnosis in England compared to 21% in Wales.

– Some 28% of patients with non-Hodgkin lymphoma are diagnosed after a trip to A&E, according to an audit of the type of cancer that develops in the lymphatic system.

– Around a fifth of patients with kidney cancer – 21% in England and 23% in Wales – were only diagnosed after their cancer had spread to another part of the body, according to the kidney cancer audit.

– The audit on metastatic breast cancer – when the cancer has spread – revealed that 44% of women survive for three years after diagnosis.

– The audit on the care of women with primary breast cancer examined certain elements of care – including whether they were given a “triple diagnostic assessment”, meaning they were clinically assessed, scanned and given a biopsy in one appointment, with 68% of patients in England and 51% in Wales given this service. The audit also reported that among women who had a mastectomy, 24% in England and 13% in Wales underwent immediate breast reconstruction at the time of their mastectomy.

Kruti Shrotri, head of health policy at Cancer Research UK, said: “Diagnosing cancer at a later stage can make it harder to treat successfully, by limiting the treatment options available to patients.

“Take bowel cancer, for example – In England, around nine in 10 people will survive for five years or more if diagnosed at stage 1, compared to around one in 10 at stage 4.

“That’s why it’s vital the UK Government does more to diagnose cancers earlier – it will save lives.

“The upcoming National Cancer Plan for England is a crucial opportunity to improve things.

“It must include a new commitment to earlier diagnosis, backed by policies to deliver it, such as fully rolling out lung screening across England. This could save around 1,500 lives every year,  even if uptake is only around 50%.”

The audits were published by the National Cancer Audit Collaborating Centre (Natcan) which is based in the clinical effectiveness unit of the Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine.

Professor Ajay Aggarwal, clinical director of Natcan and consultant clinical oncologist, said: “The power of NHS data to support major improvements in the quality of cancer care has never been greater.

“We expect the findings from the Natcan audits will be used by NHS trusts to continue to drive standards of care and reduce inequalities.”

Professor Frank Smith, vice president of the Royal College of Surgeons of England, said: “Natcan audits should act as a beacon of improvement in cancer care.

“By learning from the findings, we can work together to ensure every cancer care professional delivers best clinical practice and every patient gets the highest standard of care.”

An NHS spokesperson said: “The NHS is diagnosing more cancers at an earlier stage than ever before but we know there is more to do, particularly with some cancers, to ensure we detect it as early as possible when treatment is more likely to be successful.

“We commissioned the national ovarian cancer audit, which this report is based on, to help address unwarranted delays or variations in care for women with ovarian cancer and to drive improvements. Our network of Cancer Alliances are working to ensure all patients get the timely, personalised cancer care they need.”