C the Signs – An NHS England case study

It is an honour to be featured as a Case Study of good practice for the early diagnosis of cancer and patient survival by NHS England. Since our pilot in Sutton CCG, we are now working with 130 GP practices across 4 CCGs and have over 500 primary care health professionals using the decision support tool.


Unfortunately, in the UK the instances of people being impacted by ‘cancer poverty’ are rapidly rising. As we are all aware, a mobile phone is no longer a luxury, but a necessity – particularly when you are dealing with a cancer diagnosis. SimPal, a young and innovative charity, is providing mobile phones and pre-paid sim-cards for people affected by cancer. Currently there is no other service like this in the world.

How do we get to 3 in 4 people being diagnosed early with cancer?

Last week, the C the Signs Team were proud to present a poster about our progress at Cancer Research UK’s Fifth Biennial Early Diagnosis Conference. The conference took place over three days and celebrated the research from the last decade, alongside the implementation of evidence into policy and practice.


Jane, a 34 year old women, presents with a 2 week history of a right sided breast lump she found incidentally in the shower. The lump is non-tender and mobile. She reports regular menses and is due her next period in 4 days. There is no relevant past medical history or family history of breast cancer. She reports she commonly experiences bilateral mastalgia before her period. On examination you confirm the presence of a 2x2cm mobile lump on the right upper quadrant of her right breast. There is no associated lymphadenopathy.

What should you do next?

  1. Safety net the patient and ask her to come back in two weeks
  2. Reassure the patient and advise her that the if the lump remains after her period to come back for review
  3. Refer the patient for a non-urgent breast referral
  4. Referral the patient along an urgent 2-week-wait breast referral