Early diagnosis of cancer generally increases the chances for successful treatment by focusing on detecting symptomatic patients as early as possible. Delays in accessing cancer care are common with late-stage presentation, particularly in lower resource settings and vulnerable populations. The consequences of delayed or inaccessible cancer care are lower likelihood of survival, greater morbidity of treatment and higher costs of care, resulting in avoidable deaths and disability from cancer. Early diagnosis improves cancer outcomes by providing care at the earliest possible stage and is therefore an important public health strategy in all settings.
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Early diagnosis aims at reducing the proportion of patients who are diagnosed at late stage. There are three steps to cancer early diagnosis. Barriers exist during each of these three steps, and interventions are needed to address delays in care.
To improve awareness and access to care, a coordinated approach should be developed that includes empowerment and engagement linked to integrated, people-centred services at all levels of care. This includes improving health literacy and reducing cancer stigma. The sign and symptoms associated to cancer amenable to early diagnosis are summarized in table 1.
Building diagnostic capacity and improving referral mechanisms can overcome common barriers to timely diagnosis. Health-care providers at all levels of care should be equipped with the skills to identify cancer symptoms and perform or refer for diagnostic tests. Pathology is particularly important in cancer diagnosis; a patient should generally not begin cancer treatment unless there is pathologic confirmation of cancer. Finally, referral is made to an appropriate facility able to provide high-quality, multi-disciplinary cancer care.
Financial, geographic, logistical and sociocultural barriers must be considered and addressed as per national context to improve access to timely cancer treatment. In 2015, less than 30% of low-income countries reported treatment services were generally available, compared to more than 90% of high-income countries. Ensuring access to quality, timely cancer treatment is critical to improving cancer outcomes
Early diagnosis or screening?
Decision-making depends on a number of factors, including the cancer being targeted, the risk for a particular cancer in a specific population and the health system capacity and resources in a given country. In areas where the majority of patients are diagnosed at late stage, early diagnosis can have a great impact and build health system capacity.
Related WHO Links
- Global action plan for the prevention and control of NCDs 2013-2020
- Cancer control: knowledge into action series
- Guide to cancer early diagnosis
- WHO list of priority medical devices for cancer management
- Comprehensive cervical cancer control: a guide to essential practice
- WHO position paper on mammography screening
- Global atlas of palliative care at the end of life
- IARC Global cancer observatory
- IARC World cancer report
- Full list of publications