46 - Rethinking cancer detection

In October 2018, then Prime Minster Theresa May announced a bold new ambition: that the NHS would make sure three in four patients with cancer are diagnosed at an early stage within 10 years. Two years have passed and I am sad to say that, since then, progress has been slow – even before we account for the dreadful impact of COVID-19 on every aspect of society.

There is a risk of this becoming a huge missed opportunity – for patients, and for the UK as a whole. Scientifically speaking, we are living through a revolution in early cancer detection. New technology enables detection of traces of cancer that were previously invisible or undetectable. An ever-advancing knowledge of the disease’s early stages means, increasingly, we know what to look for, and where to look. This is creating an entire new field of research, focused on detection not treatment, but still with cure as the goal.

This opens up opportunities for innovation and investment, to translate these advances into real-life, NHS-approved tests for people with cancer, and to build a new industry around them. It’s an industry that, if it plays its cards right, the UK is in prime position to lead. Alongside a commitment to early cancer diagnosis, the UK government has a clearly-stated ambition to become a global science superpower and plans to increase R&D investment to 2.4% of the UK’s GDP.

So why has this field’s true potential remained largely unexploited – both globally, and here in the UK?

Above all, progress has been hamstrung by a market failure. Take the high cost of research and development. For a new cancer test to be implemented and adopted, the current system calls for clear evidence of an impact on cancer survival, a process which requires long, expensive studies. Compared to the pharma sector, the pathway to regulatory approval for new tests and diagnostics is often unclear. Despite recent commitments, historically there is a general undervaluing of innovative diagnostic technology by the health system. All of this creates a perfect storm, de-incentivising industry and investors from operating in this space.

On top of this, there are gaps in our knowledge, not least the health economics of early detection – something essential when making the case for investment, and to regulators.

Given the potential benefits for patients and the global growth of industrial and private finance interest in this field, it is clear that research into early cancer detection, along with innovation and healthcare provision, should form a central pillar of the UK’s approach to realising its clearly stated ambitions in both cancer and research. There is a huge opportunity to ‘de-risk’ the field and attract inward investment to the UK. And, much more importantly, there is an opportunity to revolutionise the way cancer is diagnosed, and to save countless lives.

With the devastating impact of the COVID-19 pandemic on cancer screening and diagnosis, there could not be a better time to act. Cancer Research UK’s new Early Detection and Diagnosis of Cancer Roadmap outlines a plan to establish the UK as a world leader in early cancer detection – we now need to accelerate together towards the destination it allows: a day when all cancers are cured.