Cancer survival – good news but what's the bigger picture?

A new report from Macmillan Cancer Support sounds like the stuff of three cheers. People diagnosed with cancer today are twice as likely to survive for at least 10 years as they were 40 years ago. Much of the improvement is down to screening, which is mostly designed to pick up cancer at an early stage, when survival rates are much higher. Much of the rest is down to improved treatment.

But the study also highlights the struggle that faces cancer survivors. About 35,000 people diagnosed with cancer in the 1970s (24,000 women and 11,000 men) are still alive today. Survival rates for breast cancer (around 8,000 of the survivors from the 1970s had breast cancer) are much better than for other cancers – for instance, just 800 of the survivors were diagnosed with lung cancer, the second most common cancer in the UK. Overall, there are about 2.5 million people in the UK living with cancer today. A combination of screening, better treatment and increasing life expectancy means that by 2030, that figure could be over 4 million.

My patients diagnosed with cancer these days have overwhelmingly positive stories of their experiences of treatment – the NHS two-week wait cancer pathway has largely succeeded in ensuring they get really rapid access to treatment to reduce the risk of cancer progression. Their world is turned on its head, and for months their lives revolve around hospital appointments. Charities like Maggie’s and the Haven, along with Macmillan Cancer Support, mean they don’t have to go through the journey alone and their mental as well as physical needs are catered for.

But once that first phase of treatment is over, all too many of them report being ‘dropped’ and left to fend for themselves. Cancer is a serious condition which demands serious treatment, and that often means side effects which can last for months or even years. Macmillan estimates that 625,000 people in the UK are suffering from depression as a result of cancer. Many people live in constant fear of their cancer returning. Up to 1 in 4 may suffer long-term side effects, including debilitating tiredness bladder or bowel incontinence.

It’s years since national guidelines recommended that people with cancer should have rehabilitation, along the same lines as cardiac rehabilitation for patients after heart attack. There’s a huge body of evidence for the benefit of exercise in countering the tiredness and depression that can follow cancer and its treatment. Yet it still hasn’t happened – although there are pilots planned across the country.

There’s no doubt that screening saves lives, but even screening is not without its risks. For instance, it’s estimated that breast screening for women age 50-70 (being rolled out to 47-70 in some parts of the UK) saves 1,300 lives a year – but at a cost of 4,000 women being treated unnecessarily for a cancer that they’d never have known about without screening. Bowel cancer screening is now offered to everyone in the UK and it’s estimated that 2,000 lives a year would be saved if everyone took up the invitation. But many of my patients are scared at the prospect of the investigations that might follow if their results were abnormal.

Cervical cancer screening is offered to every woman from 25-65 – but sadly figures show that levels of coverage, among some age groups at least, are dropping. In fact, cervical screening aims to pick up potentially cancerous changes so they can be treated before they ever progress to cancer. So this is a form of screening that prevents not just cancer deaths but cancer itself.

So yes, a doubling of survival in fur decades is good news indeed. But making an informed decision about screening, and taking up screening opportunities when they’re offered, is the best way to see that trend continue. And if you know someone who’s had cancer, take a moment to ask yourself if they really are completely over it. A little understanding could go a long way.

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