The ambition set by NHS England is that 75% of cancers should be diagnosed in stages 1&2 by 2028. Currently, around 50% of cancers are diagnosed early.
The early diagnosis programme in south east London aims to increase the number of patients diagnosed with cancer at an earlier stage, a key priority in NHS England’s Long Term Plan by working with system partners across South East London to implement screening and early diagnosis initiatives and interventions.
The Early Diagnosis Programme also runs an extensive education programme for primary care and previous recordings of educational webinars and support documents can be found under the training and development section of the website.
If you would like to find out further information about the screening and early diagnosis initiatives and interventions planned for this year, please contact the Early Diagnosis Lead in the Cancer Alliance via our contact form.
We are working with a number of partners across South East London to improve uptake in cancer screening programmes and to reduce inequalities across the three screening programmes:
- Bowel
- Breast
- Cervical
We are carrying out a number of projects to support recovery and increase uptake in the screening programmes. If you would like to know what you can do in your local practice or area, then please contact us.
The Cancer Alliance is working with primary care cancer leads across South East London to ensure that Primary Care Networks (PCNS) and GPs within these are kept up to date with changes and updates to pathways by:
- Developing primary care referral algorithms of changes to tumour specific pathways;
- Developing an educational plan to support PCNs in delivering the early diagnosis elements of NHS England’s Direct Enhanced Scheme, a support guide (click here for guide) has been; developed and a series of webinars have taken place to support primary care;
- Piloting C the Signs in Bexley;
- Producing a dedicated primary care lung cancer work programme due to the impact COVID-19 has had on lung cancer referrals;
- Work with the charity Live Through This to improve the awareness of cancer risk and management in the LGBTQ+ population across Primary Care.
South East London Cancer Alliance, in partnership with the Borough GP Cancer Leads are pleased to share the Early Cancer Diagnosis PCN DES Support Guide.
This interactive support guide provides PCNs with practical steps to support them in delivering the Early Cancer Diagnosis elements of the PCN DES. The guide also includes links to support and educational guidance for primary care.
We encourage PCNs to download the document to their local IT systems and discuss the content at PCN roundtables and meetings.
The support guide and the content within this will be discussed at the upcoming PCN DES workshop which is being held on 16th June.
If you have any comments regarding the PCN DES Support Guide or would like to find out more about the PCN DES workshop then please use the content button at the top of the website to get in touch with the Cancer Alliance.
King’s College Hospital at Denmark Hill has launched a new pilot to speed up lung cancer diagnosis. The implementation of direct to CT access can achieve a quicker diagnosis for people that have had a normal chest X-ray but still present with symptoms in line with NICE 12 guidelines. This will not only provide reassurance to the person but to the referring clinician also.
GPs can now refer patients aged over 40 years of age who meet the following criteria:
- eGFR in last 3-months.
- Normal recent chest X-ray undertaken that does not demonstrate lung cancer within last 3 months.
- Respiratory symptoms and GP suspicion for Lung Cancer.
SELCA is encouraging GPs in Primary Care within south east London to undertake opportunistic PSA testing on patients with a prostate who are a) aged 45 and over, and b) have either/both:
• A clear family history of prostate cancer
• Black / Caribbean ethnicity
The Suspected Prostate Cancer Pathway has been one of the slowest to recover following the COVID-19 pandemic.
It is anticipated that there are 14,000 men in England with prostate cancer that have not been identified as a result and over 300 men in SEL.
GP Cancer Leads in South East London have developed the a template initiative for PCNs to identify men at a higher risk of having prostate cancer, using searches and a florey developed specifically for the initiative. The 4th Service Requirement of the PCN DES aims to support identification of these men; “Focusing on prostate cancer, and informed by data provided by the local Cancer Alliance, develop and implement a plan to increase the proactive and opportunistic assessment of patients for a potential cancer diagnosis in population cohorts where referral rates have not recovered to their pre-pandemic baseline.”
The South East Cancer Alliance recommends that PCNs focus on men who are most at risk (target cohort):
• those with a family history of prostate cancer aged over 45
• black men aged over 45
Prostate Cancer UK have developed an online risk checker which enables men between 45-70 years of age to assess their risk and also provides them with information to help them make an informed choice about whether to have a PSA test or not. The link to this can be added to an AccuRx text so the patients can request a PSA test without having to book an appointment.
If you are interested in taking part in the pilot, then please contact estherappleby@nhs.net and you will be sent the prostate cancer risk checker link.
Please find full instructions on how to complete the intervention here. The searches which are used to monitor impact (and therefore completing any DES fulfilment template) can also be downloaded on the following links, ‘text sent and PSA done’ and ‘text sent and 2ww referral made.’
Please Note:
There are searches for men at high risk of Prostate Cancer in EMIS as part of Ardens that could be used in conjunction with this. However, they include men over >70 years of age. We would therefore recommend that the list of patients generated by any search is reviewed by a clinician prior to texts being sent to ensure only suitable patients are contacted. It would not usually be recommended to offer a PSA test to a man with a life expectancy with less than 10 years.
Your patient has recently undergone a lung health check with a low dose non-contrast CT scan of their thorax. This is part of the national Targeted Lung Health Check Programme (TLHC).
This is a centrally funded initiative, which is being piloted in Southwark and Greenwich because of the high levels of respiratory diseases, late stage lung cancer diagnosis and deprivation. T
he pilot is being overseen by local clinicians from Guy’s and St Thomas’ Hospital, King’s College London Hospital and Lewisham and Greenwich Hospital. The screening element is being contracted out to Alliance Medical and their partners. You will receive a report of the findings and the following guidance can support you and your colleagues as to how you wish to proceed.
Lung Cancer
A small number of initial CT thorax scans will present findings suggestive of lung cancer. The TLHC team will automatically refer these patients to the local Lung cancer teams and will contact the patient to inform them. You will also receive a notification.
Lung Nodules
A larger number of CT thorax scans will present a potential significant nodule. At this stage, it is not possible to determine if the nodule is cancerous or not. The majority will be benign and some can develop malignant features over time. The TLHC team will automatically provide appointments for follow up scans and will contact the patient.
Other Cancers
Occasionally, a low dose non contrast CT scan can present incidental findings suggestive of other cancers, such as Liver, Neck, and Breast. The scan protocol is focused (collimated) to just the thorax and not designed to detect other organ cancers and will not exclude them. If these are found, they require investigation and treatment in the normal way. The TLHC team will arrange the appropriate upgrade/referral for these findings.
Other respiratory findings
A minor degree of respiratory pathologies such as bronchiectasis, interstitial lung disease, and emphysema are common. The TLHC team will arrange the appropriate thoracic referral if required. If very minor changes, they will be referred back to primary care (no action required unless specified). Findings suggestive of COVID -19 will be escalated by the TLHC team.
Bone disease
Acute fractures or findings suggestive of bone malignancy such as vertebral fractures will be referred by the TLHC team to the appropriate teams in secondary care. Findings suggestive of osteoporosis will be referred to the appropriate osteoporotic clinics at each secondary care site.
Cardiovascular.
Thoracic Aortic Aneurysms/dilatation of aortic root more than 4.5cm will be referred by the TLHC team to appropriate cardiothoracic teams and the patient will be contacted to inform them.
Abdominal Aortic Aneurysm more than 5cm will be referred by the TLHC team to appropriate cardiothoracic teams and the patient will be contacted to inform them. If less than 5 cm, they will be referred back to primary care to arrange appropriate surveillance.
Liver, Pancreas, Adrenal, Renal, Thyroid
Incidental cysts and nodule findings are common and these will be characterised as far as possible radiologically as benign or requiring further assessment. These findings will be discussed in the TLHC MDM to determine whether further action is required. If there is a required further action, this will be undertaken by the TLHC team.
Minimal lung consolidation
In some cases, there will be findings of consolidation or infection. The TLHC team will write to GPs with guidance to provide antibiotics if required and a 3-month CT thorax scan will be arranged by the TLHC team.
Mild COPD/emphysema
Patients who attend for scan will have spirometry on the unit (with reversibility where available). Spirometry will not be done if completed within the last few years. Patients with spirometry suggestive of COPD with FEV1 >50% and a scan that does not show significant emphysema will be referred to primary care to manage as per SEL COPD guidelines. If they are not known to have COPD, they should have a new COPD review with appropriate coding.
Cardiovascular
Coronary artery calcification is seen on non-contrast CT scans however the protocol is not designed to undertake accurate calcium scoring for evaluation. It is presented in the majority of people over 50 years of age, particularly smokers. Coronary artery calcification correlates very poorly with symptomatic ischemic heart disease which depends on the site the calcium deposit. Coronary calcium artery disease, unless symptomatic, does not require secondary care referral. However, you may wish to consider a risk stratification as per NICE guidance and a Q risk score. If these are new findings then you may want to consider cardiovascular risk assessment (BP, lipids, Q risk).
Cardiomegaly and Aortic Valve Calcifications are also common findings and these candidates should be referred for an echocardiogram as per NICE guidance, unless already known to you.
If you have any further queries, please contact the TLHC team at gst-tr.seltlhc@nhs.net
If you’d like to find out further information about the screening and early diagnosis work programme, then please contact us.