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All patients with symptoms in a breast, irrespective of whether cancer is suspected, will be seen within two weeks of referral to a specialist under ambitious new government plans announced this week to achieve “world class services” in England.
The move is part of a raft of measures, outlined in the five year cancer reform strategy, to speed up the diagnosis and treatment of cancer and close the gap in survival between England and other countries in Europe.
Announcing the plans, Mike Richards, the NHS’s clinical director for cancer services, said, “We have made good progress on cancer over the past 10 years. However, we know there is much more to be done.”
The strategy emphasises prevention. Under consideration are a ban on cigarette vending machines, curbs on the display of tobacco products, and a review of sun bed use, particularly by people aged under 18 years.
Age thresholds for screening services will also be extended. By 2012 breast cancer screening will start at the age of 47 rather than 50 and end at 73 rather than 70, and by 2010 the upper threshold for bowel cancer screening will be extended from 70 to include those aged up to 75 (see News doi: 10.1136/bmj.39419.364063.DB).
The strategy also recommends a reduction in the time from when the decision is made to treat a patient to the actual start of treatment. It says that the 31 day maximum delay for radiotherapy should also apply to other treatments such as surgery and chemotherapy and to any subsequent treatments after a relapse.
Michael Williams, vice president of the Royal College of Radiologists, said that although this standard for radiotherapy had been set in 1993, in 2005 it was being achieved in only 50% of cases.
“It’s achievable, but it’s quite challenging,” he said. “The current vacancy rate for therapeutic radiographers is 11% and there’s a huge attrition rate of 35%.”
Other measures in the strategy include:
Professor Richards said it would be up to individual primary care trusts to set their “own challenging goals” on cancer mortality.
The government has pledged £370m (€520m; $765m) over the next three years to fund its plans. These include a 36% increase in the number of consultants involved in the care of cancer patients and a 21% increase in all types of radiographers but exclude the costs of new cancer drugs.
However, Professor Richards made it clear that the government is expecting savings of around £320m a year by 2010, largely from cuts in numbers of hospital admissions, particularly for chemotherapy.
“Delivering savings will be difficult, because it will involve a massive change in practice,” said Dr Williams. “But it’s the way to go.”
The Cancer Reform Strategy is available at www.dh.gov.uk.