It’s an experience shared by nearly two million Britons a year. You find an unexpected lump, or a mole that looks different, or you acquire a cough. You see the GP and get an urgent (ie, within two weeks) referral to a specialist. With any luck, that’s where the panic ends: you’re told it’s not cancer. (In nine out of 10 cases it isn’t.)
The number of these referrals has rocketed in recent years. Evidence suggests it has doubled since 2009. This is partly a good thing, as it means increased awareness. But it also reflects the fact that, as we tend to live longer, more of us are getting cancer – nearly one in two of us, in fact.
The NHS is creaking under the strain. According to Cancer Research UK, there just aren’t enough trained staff to deal with demand. Waiting times for treatment have been creeping up.
Not only is there more cancer, but the costs of treating it are rising too. New drugs can be eye-wateringly expensive – potentially up to £75,000 a month. NICE, the drugs regulator, is increasingly rejecting these drugs even if they extend life. (The ones that it accepts – the ones that are considered worth the price – raise costs dramatically, since older treatments like chemo and radiotherapy are comparatively fairly cheap.) More targeted, personalised medicine has a downside: the fewer possible patients a powerful new drug can treat, the more a pharmaceutical company will charge for it.
It’s no wonder, then, that a Spectator discussion on the subject, to take place at the British Museum on Tuesday next week, has the title: ‘Could cancer break the NHS?’
NHS managers think the answer has to be more money. Simon Stevens, the chief executive, wants £20 billion extra a year. This, he says, will bring Britain into line with countries like Germany and France.
But it’s unlikely to happen. So is there anything else we can do about it?
Technology offers some hope. The way that most cancer is diagnosed has stayed pretty constant for 150 years. A pathologist looks down a microscope at tissue in a slide. That looks likely to change: powerful scanners can now turn the slide into a digital image you can zoom in and out on (no need for a microscope). This makes geography irrelevant – the image can be sent to a specialist anywhere in the world, making it easier to gain a second expert opinion fast. But can it speed up the whole process, reducing costs for the NHS? That is harder to establish.
There is also the tantalising prospect of hastening diagnosis using artificial intelligence. AI, it is thought, could detect patterns in scans that indicate cancer – if not replacing physicians, then at least helping them. This kind of use of AI is much closer than we think.
Quicker, earlier diagnoses are key. They matter not just for patients, who have a higher chance of survival, but for NHS budgets, as early-stage cancer is cheaper to treat. A promising innovation in this area are Multidisciplinary Community Diagnostic Centres. They will offer patients access to dedicated facilities within the community setting helping to alleviate some of the demand on hospitals by efficiently and effectively providing earlier diagnosis using NHS protocols, and ultimately better patient survival rates.
Beneath the grim economics there is plenty of good news. Cancer survival is better than ever. New treatments have had staggering results, eliminating advanced cancers and dramatically extending lives. Old treatments, too, are continually being fine-tuned, becoming ever more effective.
But the future looks expensive. Can the NHS afford it?
The Spectator and Philips will be discussing this and more on 28 November at the British Museum. The guest panel include: George Freeman MP, Prof Karol Sikora, Sarah Woolnough of Cancer Research UK and Neil Mesher of Philips UK & Ireland. Click here to register for your complimentary ticket.