Transformation Partners in Health and Care > Stage 1 and 2 cancer diagnosis

Stage 1 and 2 cancer diagnosis

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 for CCGs (2018).  This also varies across tumour types with the biggest potential for change in lung and abdominal cancers. Primary care referral optimisation was also included as 66% of patients first present with symptoms of cancer in a primary care setting.

To identify and agree what would deliver stage shift across the region a series of workshops were held bringing together the London Alliances, clinical experts, charities, and patients. These stakeholders and experts worked together to reach a consensus and agreed three priority areas to focus London’s  improvement activity on with the Transforming Cancer Services – Earlier Diagnosis Team.

The key priorities decided were GP referrals, lung cancer and abdominal cancers.  Approaches agreed within the priority areas are summarised below:

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.


  • 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.


  • 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 (RDC or other).


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