Cancer diagnosis (DISCO)

How we are improving cancer diagnosis: investigating the right patient, at the right time, with the right test

New cancer risk assessment tools for GPs: who should be tested?

We have identified which symptoms of cancer really matter, which will in turn help GPs spot possible cancer earlier. As well as identifying the relevant symptoms, the team seeks to quantify each symptom, thereby estimating the percentage risk attached to each symptom or combination of symptoms. The team has produced charts on cancer risk that are now being used for 18 cancers in UK GP surgeries. They are also in use in parts of Australia, Denmark and Sweden. The data from these charts also strongly influenced the 2015 revision of NICE guidance on investigation of possible cancer. The system is now being tested as software for GPs' clinical computers, prompting when the risk of cancer is above 2%.

From 2010-5 this research was supported by a National Institute for Healthcare Research (NIHR) programme grant, DISCOVERY, and from 2011-8 through the Policy Research Unit for Cancer Awareness, Screening and Early Diagnosis. The early implementation of Risk Assessment Tools was supported by the Department of Health, CRUK and Macmillan.

Commencing in 2019, a cluster-randomised trial will test the clinical and cost-efficacy of six of these electronic risk assessment tools in 710 UK practices, supported by a generous philanthropic donation from the Gillings Foundation.

The Policy Research Unit funding has now been renewed for the years 2019-2024. The research is also supported by the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC). PenCLAHRC is a partnership between all of the local NHS organisations, the College of Medicine and Dentistry and the Universities of Plymouth and Exeter and aims to improve health through carrying out medical research which directly addresses local health needs.

The research team is led by Professor Willie Hamilton and includes Dr Liz Shephard, Dr Sarah Price, Dr Luke Mounce and Dr Raff Calitri.

New cancer investigations for GPs: how can we test for cancer?

The CRUK flagship CATALYST award, the CanTest Collaborative programme, which we co-lead with Cambridge from 2017-2022, studies how testing for cancer can take place in the GP surgery – will existing tests still work? Will new tests perform well? Will GPs and patients accept the shift of responsibility to primary care? Will the health economics support this transfer? This award also provides educational support to foster another generation of cancer diagnostic researchers. Currently, we have started nearly 30 studies across the four UK and five international institutions in Cantest. Over the next three years, these will produce a large body of evidence for policymakers about testing in primary care. The Exeter team, comprising of Prof Anne Spencer, Dr Gary Abel, Dr Sarah Bailey, Dr Sam Merriel, Rebekah Hall and Dr Sara Hayes, is one of nine based across the UK and beyond in Denmark, The Netherlands, Australia and the United States.

New features of cancer: what is the platelet story?

One exciting new finding has been that a patient’s blood platelet count may rise long before cancer is diagnosed. Early work from our team hinted at this, but confirmation came with one of our prize-winning papers, showing adult men with high platelet counts had an over 11% chance of cancer; for women, this was over 6%. This major finding has led to many research questions, such as: why is this happening? Can we use this as a test or even a cancer screening tool? Is there also a high risk of cancer in patients whose platelet count is at the upper end of normal? We have already received funding to study some of these questions and will be expanding our work in this field in the coming years. This research, led by Prof Willie Hamilton, Dr Sarah Bailey, Dr Luke Mounce, Dr Liz Shephard and Dr Giordano Pula, is supported by the Policy Research Unit.

New guidance for cancer testing: what effect has it had?

The 2015 NICE guidance on investigation of possible cancer was a major landmark. However, it is crucial to know what impact it has had. Our team, comprising Dr Sarah Price, Prof Willie Hamilton, Dr Gary Abel & Prof Anne Spencer, are studying changes in time to cancer diagnosis over the past 15 years, and whether this has led to improvements in cancer stage at diagnosis, and how much cancer survival is improving. This work, funded by CRUK will inform us on how much of current UK cancer improvements are due to better diagnosis or due to better treatment (or both).