QualityWatch: Younger people and people of minority ethnicities have more visits to a GP before a cancer diagnosis

The number of visits to a GP surgery needed ahead of a cancer diagnosis varies depending on a person’s age, ethnicity, and socioeconomic status, according to new analysis of NHS cancer data published today.

While the route to a diagnosis varies between different types of cancer and individuals’ experiences of care will be different, people of Mixed, Black, and Asian ethnicities and young people (16-24) require a higher-than-average number of interactions with a healthcare professional from a GP practice before they are diagnosed with cancer. 

The analysis from QualityWatch, a joint programme from the Nuffield Trust and the Health Foundation, of available NHS cancer diagnosis data, finds that:

• For 16–24-year-olds, one in every two required three or more interactions with a healthcare professional from a GP practice before being diagnosed and for 20% of this group, five or more interactions were required. But despite multiple interactions, young people are still more likely to be diagnosed at an early stage in their cancer.

• 1 in 3 people of Mixed, Black or Asian ethnicity required three or more interactions with a GP. 

• On average across the whole population 1 in 5 people had three or more GP interactions before being diagnosed.

• People from the most deprived populations in England are 21% less likely to be referred for urgent suspected cancer than those from areas with low levels of deprivation. 

The analysis also revealed concerns about the quality of communication received following a diagnosis of cancer:

• 3 in 5 16–24-year-olds when referred for a diagnostic test did not feel that the reason for their referral was explained to them in a way they could completely understand. 

• Across the population, 1 in 4 people said that when they were first told they had cancer it wasn’t explained in a way that they fully understood. 

Concerns about the experience of getting a cancer diagnosis should give pause for thought to policymakers as the NHS looks set to miss its own target to have 75% of cancers diagnosed at an early stage by 2028. Efforts to diagnose cancer at earlier stages has flatlined in recent years and currently, only 60% of cancer diagnoses are taking place before the cancer has progressed. 

The analysis also looked at NHS cancer screening rates for breast, bowel and cervical cancers as a route to early diagnosis. While these programmes have been successful at increasing the number of early-stage diagnosis for these cancers (78% referred at stage one or two), the authors caution that screening alone isn’t the answer to improving the rates of early diagnosis, with the risk vs benefit ratio varying by cancer type and highly dependent on the patients who come forward.

While the circumstances of each cancer diagnosis will vary, and depend partly on the type of cancer, a mismatch between investment and the demand pressure on cancer diagnostic services and access to general practice remain a barrier to the NHS’s ambition for faster cancer diagnosis. The authors also call on the NHS and government to implement more tailored support for some population groups around screening and patient communication when receiving a diagnosis.  

Nuffield Trust Senior Fellow Dr Liz Fisher said: “Delays to a cancer diagnosis pose real risks for people and an early diagnosis plays a pivotal role in determining the treatments available to people and determining outcomes. Detecting cancer early is vital to improving survival rates, for example, the rate of survival for bowel cancer drops significantly from 80% if caught in stage 2 to 11% at stage four. 

“The NHS has set an ambitious goal to dramatically increase early detection of cancer, but performance in this area has stubbornly stalled in recent years. Everyone’s experience of cancer diagnosis is different but the risks to delays aren’t felt equally, with younger people and those from minority ethnic groups requiring more visits to health professionals to secure a diagnosis. Screening programmes have helped for some cancers, but more needs to be done to target support to specific groups given demand on cancer services is only set to grow.” 

The Health Foundation Assistant Director of Policy Tim Gardner said: “For cancer, quick diagnosis and treatment saves lives. Recent progress on the rate of people receiving a cancer diagnosis within 28 days of a referral is very welcome. However, this analysis highlights the need to improve people's access to primary care, especially in more deprived areas, so that more people can be diagnosed earlier. This ultimately depends on boosting primary care capacity through sustainable, long-term investment and growing and supporting the workforce.”

Ends.