Trisha Goddard discusses her breast cancer in 2018
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In their study, cancer epidemiologist Professor Georgios Lyratzopoulos of University College London and his colleagues analysed data on more than 850,000 cancer cases in the UK, Australia, Canada, Denmark, New Zealand and Norway from 2012 to 2017. They found that more than a third of cancers in the UK are only detected after patients are rushed to hospital in an emergency situation — rather than being picked up early — with only New Zealand having a worse figure at 42.5 percent. Moreover, the team found that countries like the UK and New Zealand that had higher incidences of emergency discoveries also tended to have poorer patient survival rates. As International Cancer Benchmarking Partnership clinical lead Dr John Butler notes, “Cancers diagnosed through emergency routes are often more advanced than those caught after GP referral or through screening. “This can affect someone’s chances of surviving cancer, and affects the type of treatment they’re offered.”
Prof Lyratzopoulos said: “This is the first population-based study to ever look at diagnoses of cancer through emergency presentations internationally and to examine their link to survival.
“It has given us valuable insights into which patients and cancers are more likely to be diagnosed after an emergency hospital admission. Vulnerable patients — those who are older or with advanced disease — are disproportionately affected around the world.
“The data tell us that emergency presentations are a global problem — and not concentrated in a single country or health system.
“Getting better at preventing cancer, detecting it through screening, or diagnosing it soon after symptoms appear can help decrease emergency presentations and reduce cancer deaths. This message applies to Canada, Europe and Oceania, as well as the UK.”
Cancer Research UK — which helped fund the research — has expressed concern that the situation may have deteriorated during the COVID-19 pandemic, which began sometime after the researchers’ dataset ended and made it more difficult for people to visit their doctors and take advantage of routine screening.
Michelle Mitchell, Cancer Research UK chief executive, said: “For months we have been warning that cancer survival could go backwards due to the pandemic.
“The UK is already lagging when it comes to cancer survival – this study helps us understand why, showing that countries with higher levels of emergency presentations have lower survival.
“If we want to build a world-class cancer service, we need to learn from comparable countries and ensure fewer patients are being diagnosed with cancer after an emergency referral or trip to A&E.”
Cancer Research UK is calling on the Government to take action to ensure that — by 2032 — fewer than five percent of all cancer cases are diagnosed through emergency routes.
The full findings of the study were published in the journal The Lancet Oncology.
The flagging of the UK’s failings when it comes to early cancer diagnosis comes as the National Institute for Health and Care Excellence (NICE) has published initial guidance recommending against the use of sacituzumab govitecan for advanced or metastatic triple-negative breast cancer.
This form of cancer is typically more aggressive than its counterparts, accounting for around a quarter of all breast cancer death despite only making up 20 percent of all cases.
The drug — which is manufactured by Gilead Sciences under the brand name “Trodelvy” — first targets so-called Trop-2 proteins on the surface of tumour cells in order to deliver its anti-cancer component that helps prevent these cells from multiplying.
Trodelvy has been shown to slow down cancer progression and increase life expectancy in comparison with chemotherapy.
Despite being approved for use in Scotland last month, NICE has advised that “at its current price, it is too expensive to be considered a cost-effective use of NHS resources”.
Trodelvy has a list price of £793, excluding VAT, per 180 mg vial — three of which are required to complete a 21-day dose cycle, although some patients would require higher doses or longer treatment courses depending on their particular circumstances.
According to NICE, 650 patients of the 2,000 in the UK presently living with triple-negative breast cancer could have benefited from treatment with sacituzumab govitecan had it been recommended.
NICE’s interim director of medicines evaluation, Helen Knight, said: “Because sacituzumab govitecan is a highly effective treatment, and given the lack of treatment options for people with this type of breast cancer, we’re very disappointed that its price means we can’t recommend it for use in the NHS at this point.
“We hope that the company will consider what it can do to enable NICE to approve a treatment that has the potential to give people with advanced triple-negative breast cancer more time with their loved ones.”
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A spokesperson for Gilead Sciences told Express.co.uk: “While this is a draft recommendation, it is extremely disappointing, particularly given the recent decision from the Scottish Medicines Consortium to accept SG for NHS use in Scotland.
“Following positive recommendations in Switzerland, Canada and Australia, Great Britain is now the only Project ORBIS country not to have reimbursement for SG – despite it joining the Project to improve speed of access to innovative new cancer therapies.
“A second committee meeting has been scheduled for the 10th of May 2022 and Gilead will be working closely with NICE to address questions raised around cost-effectiveness estimates.
“We believe we have put forward a strong, cost-effective case for the reimbursement of SG in England and are deeply concerned by the prospect of unnecessary delay, especially in a cancer where every day matters.
“Gilead will continue to provide SG free of charge to women in England, Wales and Northern Ireland through our pre-reimbursement access scheme for as long as possible.
“However, our focus remains on securing a positive recommendation from NICE that would provide long-term, sustainable access to SG for all those who need it.”
Breast Cancer Now chief executive Baroness Delyth Morgan, told the Telegraph that NICE’s decision was a “devastating blow” for the patients the drug could have helped.
She added: “These women, who already face devastatingly poorer prognoses and limited treatment options, deserve the chance to benefit from this new treatment option.”
An NHS spokesperson told Express.co.uk: “This study examines people diagnosed between 2012 and 2017 and actually the proportion of cancer patients who are diagnosed through an emergency route has been falling steadily since then.
“NHS staff have been referring more people for urgent cancer checks over the last 11 months than ever before with more than 200,000 patients checked in January alone, so please come forward if you have symptoms — coming forward for checks early could save your life.”
Express.co.uk has contacted the UK Health Security Agency (UKHSA) and the Medicines and Healthcare products Regulatory Agency (MHRA) for comment.
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