Cancer testing at home is the future of the NHS

It rarely takes more than a few minutes before we’ve convinced ourselves it could be cancer. The reason that’s so frightening is that, for a small proportion of the people searching, it will be cancer.

One of the most worrying symptoms to discover is blood in your urine. A quick search will tell you it can be caused by several things, including bladder cancer, an aggressive disease that can be fatal when found too late.

Around 320,000 people in the UK visit their GP each year with blood in their urine. Many more will put off making an appointment, either through embarrassment or in the hope that it will go away. For all of them, cancer is likely to be on their mind. The good news is that around 93% of people referred will find that they don’t have bladder cancer. The problem is that finding out which group you’re in can take weeks or even months.

The standard way of looking for bladder cancer has followed the same basic principle for more than 100 years. A camera on the end of a long tube is passed through the urethra and into the bladder. This hospital procedure, known as a cystoscopy, can be painful, embarrassing and time-consuming. It is also difficult for the NHS to provide enough of them.

Under the Faster Diagnosis Standard, 80% of people urgently referred with suspected cancer should be told within 28 days whether they have cancer or whether it has been ruled out. Recent NHS data for suspected urological cancers showed that fewer than three in ten people who were ultimately found to have cancer received their diagnosis within 28 days.

More than 403,000 people are now diagnosed with cancer in the UK each year, while the proportion diagnosed at an early stage has barely changed over the past decade. We can’t meet that rising demand by relying only on hospital procedures developed more than a century ago.

Bladder cancer is much more treatable when found early, so the route to diagnosis really matters. People without cancer may undergo an invasive hospital procedure they didn’t need, while people with cancer can face a longer wait for diagnosis and treatment.

The basic problem is that the 7% of people with blood in their urine who do have bladder cancer must wait in the same queue as the 93% who don’t. Until recently, there’s been no reliable way of knowing who needs to be seen most urgently without sending large numbers of people for cystoscopy. That’s now beginning to change with ultra-sensitive cancer tests that can look for signs of cancer in a urine sample, without the need for a camera, a procedure or a hospital visit.

GALEAS Bladder is one such test that looks for genetic changes linked to bladder cancer in a urine sample. The patient provides the sample at home, freeposts it to a laboratory and receives the result through their doctor. In NHS trials, the test detected bladder cancer accurately across different stages and grades, while giving patients a clear answer around 50% faster than the traditional pathway.

In practice, this can help doctors identify people at higher risk sooner and prioritise them for further investigation and treatment. Those at lower risk may be able to avoid an unnecessary cystoscopy altogether, when their doctor considers that safe and appropriate.

For patients, that can mean getting an answer sooner, at home, without being sent straight for a painful procedure. And for urology teams, it means focusing scarce cystoscopy appointments on the people most likely to need them, rather than simply asking stretched NHS services to keep doing more of the same.

Eligible patients at University Hospitals of Leicester are now the first in England to access GALEAS Bladder through the NHS, following earlier adoption by two NHS health boards in Wales. These patients are beginning to receive clearer answers in days rather than waiting weeks for an invasive test they may not need. That’s less waiting before normal life can continue unburdened by worry about their family’s future.

At a roundtable we hosted in Parliament last month, bringing together clinicians, researchers, patient voices and government, we kept coming back to the question of access. Clinicians clearly want better options, and patients shouldn’t face a postcode lottery in whether they can benefit from them. What’s harder to explain is why access to a non-invasive test can still depend on where someone lives or which local service has managed to adopt it first.

That is the question Health Ministers should be asking. Once the evidence and clinical confidence are there, why can good practice still take so long to spread from one part of the NHS to another?

Anyone who finds blood in their urine should contact their GP. They shouldn’t ignore it or try to diagnose themselves online. But once they have asked for help, they shouldn’t have to wait for weeks in fear or undergo a painful procedure they may not need, simply because an easier test hasn’t been adopted where they live.

At-home bladder cancer testing can help doctors make better decisions earlier, give patients clearer answers sooner and focus specialist time on the people who need it most. If NHS innovation is going to mean anything to patients, proven innovations need to move beyond the first few adopters, so all patients have equal access to the care they need.

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Jeff Bousfield is the CEO of Nonacus.

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