Making cancer care safer: what we’ve learnt from our investigations

For example, delayed or missed cancer diagnosis can have life-changing consequences for patients and their families. On World Cancer Day – 4 February 2026 – we draw together what we’ve found and highlight our recommendations that aim to make cancer care safer.

What we found

Our investigations highlight systemic challenges, rather than individual errors, including the following.

Missed detection of lung cancer on chest X-rays

Chest X-rays are often the first test for suspected lung cancer, but around 20% of lung cancers can be missed. This leads to delays in diagnosis and treatment, reducing survival chances. We explored why these misses happen and how to prevent them.

Failures in communication or follow-up of unexpected radiological findings

Sometimes, significant findings on X-rays are not communicated or acted upon promptly. This can result in delayed diagnoses and poorer outcomes for patients.

Recognition and referral of suspected cancer

Identification of barriers in the referral pathways, including challenges for independent providers referring patients into NHS cancer pathways and delays in acting on abnormal test results.

These cross-cutting patient safety themes come up multiple times in our cancer-related reports:

• missed detection and diagnostic error
• communication and follow-up failures
• referral pathways and access
• continuity of care after treatment
• palliative care and advanced disease
• surgical care
• booking systems and organisational factors.

Safety recommendations

To improve the care that patients with cancer receive, since 2019, we have made 21 safety recommendations that address these systemic challenges across seven investigation reports, including:

Update safety netting advice for GPs

We recommended that national guidance for suspected cancer (NG12) should be made clearer on what should happen when patients have ongoing symptoms after a negative chest X-ray. Updates to the Safety Netting given in NG12 were to be reviewed – this could support improved communications and guidance to patients.

Supporting earlier diagnosis

We recommended research into whether low-dose computed tomography (CT) is clinically and cost-effective for the diagnosis of lung cancer in symptomatic patients seen in primary care and consider the most appropriate way of building up the evidence base on this topic. The National Institute for Health and Care Research (NIHR) commissioned research that should inform future clinical trials and ultimately improve care.

Improve communication of radiology findings

We advised healthcare organisations to strengthen systems for communicating unexpected significant findings, ensuring results are acknowledged and acted upon promptly. As a result of our investigation, the Academy of Medical Royal Colleges published 'Alerts and notification of imaging reports: recommendations' in October 2022. The main objective of this guidance is to ensure prompt and effective imaging result notification and its subsequent action to protect patient safety.

Enhance referral pathways

We identified improvements in how independent providers refer patients into NHS cancer pathways and how abnormal test results should be escalated quickly.

Why this matters

Cancer survival rates depend heavily on early detection and timely treatment. By addressing these systemic challenges, we aim to reduce delays, improve communication, and ultimately save lives.