THE Scottish Government has published its 10-year cancer strategy, so where are we now with cancer care and what does it hope to change for patients over the coming decade?
What is the Cancer Strategy?
The cancer strategy sets out what the Scottish Government's priorities and goals are for improving cancer care over the coming decade, up to 2033.
As well as the 10-year strategy, the Government has published a 136-point action plan covering the next three years which is geared to helping cancer services in the NHS "stabilise and recover" following the pandemic.
Publication of the report had been expected in Spring, but this was delayed by the SNP leadership race which saw former health secretary Humza Yousaf take over as First Minister.
What are the key points?
One of the main goals is to halve the percentage of cancer cases which are detected at a late-stage.
At the moment, nearly half (42 per cent) of cases are diagnosed at stages III or IV. By 2033, the Government wants this to reduce to 24%.
Lung cancer - one of the most common forms of the disease - will be a focus with the introduction of targeted screening for high-risk adults aged 55 to 74.
Efforts will also focus on identifying some of the least survivable cancers - such as pancreatic cancer - at an earlier stage.
The Government also wants to prevent more cancers from ever occurring through public health measures geared at cutting smoking, obesity, and alcohol consumption. It is estimated that around 40% of cases are avoidable.
What's the problem for the NHS?
Performance against key waiting times targets have been sliding - particularly since early 2022.
The 62-day standard has not been met since the beginning of 2012, mainly due to bottlenecks at the diagnostic stage which mean that patients are waiting too long between their initial referral for tests and the start of treatment.
An ageing population means that ever if the cancer rate declines per 100,000 population (for example, because fewer people are smokers) the actual incidence of the disease will still go up because older adults are much more likely to develop cancers.
This means that the NHS has to expand its capacity to deal with cancer, and staffing shortages are a major roadblock.
One avenue will be expanding the use of new diagnosis tools, such as colon capsules - tiny cameras which patients can swallow - which can help to diagnose bowel cancer without a colonoscopy.
It is also hoped that artificial intelligence could help with imaging - identifying signs of cancer in X-rays and scans.
Forecasts currently anticipate that NHS Scotland will have around 30% fewer consultant radiologists than it needs to cope with demand by 2026, and there is a global shortage of these specialists.
Is incidence going up?
According to a report earlier this year from Public Health Scotland, there were 35,379 new cancers registered in Scotland in 2021. This is an increase of 5.5% compared to 2019.
The incidence rate (which adjusts for changes in population demographics over time, such as the size and age profile of the population) has also increased by 3.1% to 644 per 100,000.
This was higher than expected based on long-term trends, but may reflect an upsurge in cases being picked up in 2021 that were missed in 2020 due to factors such as pauses in routine screening.
By 2040, the number of cancer cases occurring in Scotland each year is expected to increase by 20%, to 42,100, mainly due to an ageing population.
What's happened to cancer survival and mortality since Covid?
A recent report by Public Health Scotland found that people who were diagnosed with cancer in 2020 had lower levels of one-year survival compared to cancer patients diagnosed in 2018 or 2019.
The reduction in one-year survival was particularly pronounced for those diagnosed during the second quarter of 2020, when the country was in lockdown.
However, it is still unclear to what extent this pattern is due to cancer services being disrupted during the pandemic, and how much is due to the different profile of the cancer patients diagnosed in 2020.
For example, the pause to bowel, cervical and breast screening means that there would have been a reduction in the proportion of very early stage cancers being detected.
By the end of 2020, one-year survival had returned to similar levels compared to pre-pandemic.
Figures for 2023 also indicate that the cancer mortality rate in Scotland (age-adjusted, per 100,000) is 2.1% lower than the five-year average at a time when the overall mortality rate - for all causes - is up by 2.6%.
This may reflect improved availability of life-extending treatments, such as immunotherapy.
However, it is also possible that the reduction the cancer mortality rate may have been even steeper if Covid-related disruption had never occurred.
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