Behind the lens
‘When patients are diagnosed at an early stage, they generally have better outcomes, so earlier detection really matters.’
One in two of us will get cancer in our lifetime. Worse, the UK has had poor cancer survival statistics for the last 25 years when compared with other European countries, due largely to diagnosing cancer too late. Here at Exeter, our researchers are producing high-quality evidence to improve this.
We spoke to Professor Willie Hamilton and Associate Professor Sarah Bailey about the work they’re doing to speed up cancer diagnosis in the UK and internationally.
The DISCO (Diagnosis of Symptomatic Cancer Optimally) research team, under Willie’s leadership, informs national guidelines for GPs, helping them identify and investigate patients who may be harbouring cancer. Willie and his team have identified all the important symptoms of cancer commonly presented by patients to their GP and have estimated the percentage risk of cancer attached to each symptom. This process has now been automated within the GPs’ computers, prompting them when the risk of cancer is above 2%.
The team has produced charts on cancer risk for the main 18 adult cancers in UK GP surgeries, which are also used in parts of Australia, Denmark and Sweden. A major randomised control trial of these began in 2019, reporting in late 2025, supported by a £2 million philanthropic donation from the Dennis and Mireille Gillings Foundation.
Willie’s research has had a major impact on improving diagnosis of cancer. Of the 210 National Institute for Health and Care Excellence (NICE) recommendations, 100 can be traced back in part, or wholly, to his publications. These new guidelines have contributed to meeting the target of reducing the number of avoidable cancer deaths in the UK by 10,000. The battle is not yet won, but patients are being diagnosed earlier and cancer survival rates are improving.
Willie says, “It’s really exciting that the cancer survival figures in this country are starting to improve. This may well be because of the work we’re doing – in part at least. Our research has meant that thousands of people are alive who otherwise wouldn’t be. When I first started this research, I hadn’t realised how much needed to be done.”
Professor Willie Hamilton.
‟Our research has meant that thousands of people are alive who otherwise wouldn’t be.”
Sarah joined the DISCO project team in 2014, and her programme of research includes new strategies for earlier cancer detection, and personalised approaches to testing in primary care.
Sarah’s PhD studied thrombocytosis (raised platelet count) occurring before cancer diagnosis. She found that thrombocytosis is an important marker of undiagnosed cancer: adult men with thrombocytosis had an over 11% chance of cancer; for women, this was over 6%. This work has significantly impacted clinical practice since publication in 2017, and in 2023, Sarah won the Outstanding Early Career Researcher Award 2023 for her work, awarded by the Society of Academic Primary Care and Royal College of General Practitioners.
One exciting new finding is that thrombocytosis may occur long before cancer is diagnosed. This opens up many research questions: why is this happening? Can we use this as a test or even a cancer screening tool? Is there also a higher risk of cancer in patients whose platelet count is at the upper end of normal?
Sarah says, “When patients are diagnosed at an early stage, they generally have better outcomes, so earlier detection really matters. Earlier cancer diagnosis is a challenge as many of the features of early cancer are vague and much more likely represent something that isn’t cancer. We want to find better ways to identify people who may benefit from investigation for possible cancer. Our work is funded by government organisations such as the National Institute for Health Research (NIHR), charities such as Cancer Research UK, and philanthropy. Philanthropic funding is important for us as it allows us to react more quickly to the needs of the NHS, and to undertake the crucial work to ensure our research outputs result in changes in practice.”
Associate Professor Sarah Bailey.
‟We want to find better ways to identify people who may benefit from investigation for possible cancer.”
An example of a philanthropically funded project with significant impact is the HELP Flag (High or Elevated Level of Platelets Flag) project. This innovation is currently being implemented in the NHS to help general practitioners to investigate patients with thrombocytosis in a routine blood test. HELP Flag uses a routine blood test more effectively to spot the very earliest signs of cancer, meaning it costs the NHS very little to implement. HELP Flag was only possible with the support of philanthropist David Walton. His gift meant that the team could respond quickly to the need for more advice on how to investigate patients with unexpected thrombocytosis.
A philanthropic gift for the cancer team from David and Kirsten Higgins has funded a study of genetic risk scores for prostate cancer in the assessment of men with urinary symptoms, the first to establish the clinical value of genetic risk in this setting. Philanthropic support was crucial here for this ‘proof of principle’ work. The DISCO team are now expanding this work to other cancers with further support from the Higgins family. This could completely change how GPs investigate patients for cancer risk.
Key parts of this work in early cancer diagnosis would not have happened without the generosity of donors. We’re extremely thankful to the Dennis and Mireille Gillings Foundation, David and Kirsten Higgins, and David Walton for their support of Willie and Sarah’s work.
