The NHS set out an ambitious goal in their NHS Long Term Plan (LTP) (published in January 2019) that, by 2028, 75% of people diagnosed with cancer will be diagnosed at stage 1 or 2.

The percentage of stage 1 and 2 diagnoses ranges from 52.1% to 59.1% across London for the latest available data (2018).  This also varies across tumour types with the biggest potential for change in lung and abdominal cancers. 66% of patients first present with symptoms of cancer in a primary care setting.

The London cancer alliances, clinical experts, charities, and patients worked with us to agree three priority areas to improve cancer diagnoses: GP referrals, lung cancer and abdominal cancers.

General Practice

• All GPs to have received training in key aspects of early cancer diagnosis.
• Promote use of simple cancer tests in general practice to risk assess patients not meeting two-week-wait/ Urgent Suspected Cancer (2ww/USC) pathway criteria e.g. FIT, CA 125, FBC, calcium, paraprotein, PSA, chest x-ray (CXR) and ultrasound (US).
• All GPs have direct access to urgent investigations in line with NG12.
• Targeted work with practices that are outliers for 2ww/USC and chest x-ray (CXR) referrals.

Lung

• Promote use of CXR in line with Leeds study.
• All GPs to have easy access to computed tomography (CT) chest for suspected lung cancer (direct access or USC pathway).
• Develop Pan-London approach to raising population awareness of lung cancer symptoms and screening.

Abdominal

• All GPs have direct access to urgent CT abdomen and US in line with NG12.
• All GPs to have access to vague abdominal symptoms service (through a Rapid Diagnosis Centre (RDC) or other).

For more detail on the planned improvement activity for these priority areas please download the TCST London Stage shift Ranked Priorities