Artificial intelligence that scans doctor records to find hidden patterns has helped doctors detect significantly more Cancer incidents.
The rate of cancer detection rose from 58.7% to 66.0% in general practitioners using the “C the Signs” AI tool. It analyzes a patient’s medical record to compile their past medical history, test results, prescriptions and treatments, as well as other personal characteristics that may indicate cancer risk, such as their zip code, age and family history.
It also asks GPs to ask patients about any new symptoms, and if the tool detects patterns in the data that indicate a higher risk of a specific type of cancer, then it recommends which tests or clinical pathway the patient should be referred to.
C the Signs are entered in about 1,400 practices England – around 15% – and was trialled in May 2021 in 35 practices in the East of England, covering a population of 420,000 patients.
The results, published in the Journal of Clinical Oncologyshows that the cancer detection rate rose from 58.7% to 66.0% by March 31, 2022, while those practices not using the system remained at a similar rate.
Bea Bakshi, a GP who created the system with her colleague Miles Payling, said: “It could be a scan, an ultrasound, or they might need to be seen by a specialist at a clinic. “
Patients are tracked by the C the Signs system to remind doctors to check test results and referrals elsewhere. “Our system detected more than 50 different types of cancers,” Bakshi said. “The most important thing is that it’s not just an earlier diagnosis, but a faster diagnosis.”
Bakshi and her colleagues also tried to validate the tool by assessing 118,677 patients in a previous study, which found that 7,295 were diagnosed with cancer and 7,056 were successfully identified by the algorithm.
Where the tool concluded that a patient was unlikely to have cancer, only 239 out of 8,453 had a confirmed cancer diagnosis within six months (about 2.8%). Bakshi developed the tool after meeting a patient in the hospital who received a late diagnosis of pancreatic cancer and died three weeks later.
“It stuck with me as a problem area,” she said. “Why are patients with cancer diagnosed so late?”
The UK has three cancer screening programmes, for bowel, breast and cervical cancer, but there are 200 different types of cancer which can be asymptomatic or create symptoms that are easily confused with other conditions.
“Two-thirds of deaths are in the non-screenable cancers and the ones we don’t screen for,” Bakshi said. “Patients visit GPs between three and five times before they are recognized as being at risk of cancer. General practitioners detect an average of eight cases of cancer per year.”
GPs use guidelines from the National Institute for Health and Care Excellence to make decisions about when to make a cancer referral.
“They are quite comprehensive guidelines, but no GP can remember them all,” says Peter Holloway, a GP who chairs the East of England Primary Care Group. Cancer Alliances and a co-author of the study.
“We know that many cancers present with vague symptoms and some are difficult to define and do not necessarily match our guidelines.”
Holloway saw a patient in his early 60s who had diarrhea and some lower abdominal pain. “Very common symptoms, and not things that would lead you to do a referral for suspected cancer,” he said. But the C the Signs tool recommended a fecal test.
“The test was positive, he was referred and he turned out to have colorectal cancer, which was diagnosed early and successfully treated,” Holloway said. “He is doing well, but if we had followed the rigid guidelines, he might not have been referred for several months.”
The NHS England’s Long Term Plan for Cancer aims to have 75% of all cancers diagnosed by stage one or stage two by 2028. The NHS is also researching whether the Galleri blood test, which tries to detect DNA from more than 50 different types of tumours, is effective. The trial began in September 2021, and 140,000 people were tested.
Holloway said that decision support systems such as C the Signs have been an important part of cancer detection, along with improving patient awareness of different types of possible symptoms of cancer, and gaining better access to diagnostic technology such as CT and MRI scanners.
Prof Peter Johnson, National Clinical Director for Cancer at NHS England, said: “Despite increased demand and pressure on services, record numbers of people are being checked and treated for cancer, and we are now diagnosing a greater proportion of cancers at an early stage. which increases people’s chances of survival.
“We know we have a lot more to do to help people with cancer get the care they need, and using the latest technology is an important part of our work to reduce waiting and catch cancers earlier track, such as ‘teledermatology’ to diagnose skin cancer, or community lung trucks, and home tests for bowel cancer.