BACKGROUNDIn October 2021, NHS England announced the creation of 40 new community diagnostic centres in England. The aims are to create faster, more direct access to diagnostic testing, divert patients from hospital to reduce waiting times and the spread of COVID-19, and tackle the backlog of diagnostic activity created by the pandemic. GPs will be able to refer patients to local centres directly for diagnostic tests and reduce the need for hospital outpatient visits. These centres will purportedly be established closer to people's homes in community hospitals, health centres, repurposed buildings, and even shopping centres, and are planned to be fully operational by March 2022. 1 Further funding for community diagnostic centres was announced in the Chancellor's Autumn Statement, taking the total number of centres to be funded to 100, as well as funding for the purchasing of additional diagnostic equipment such as computerised tomography (CT) and magnetic resonance imaging (MRI) scanners. 2 The drivers for this new initiative stem in part from the NHS Long Term Plan, published in 2019. 3 Professor Sir Mike Richards, the first NHS National Cancer Director, was commissioned by NHS England to undertake an independent review of NHS diagnostic services following publication of the Long Term Plan, and a key recommendation from his report was the establishment of community diagnostic hubs away from acute hospitals that could be delivered in a COVID-19-safe manner as much as possible. The Richards report also recommended separating acute and elective diagnostics, redesigning diagnostic pathways to better utilise triage tests (for example, faecal immunochemical testing), and a significant investment in diagnostic infrastructure and workforce. 4 This intervention from NHS England comes in the context of serious chronic challenges with access to diagnostics.

Background Global annual cancer incidence is forecast to rise to 27.5M by 2040, a 62% rise from 2018. For most cancers, prevention and early detection are the most effective ways of reducing mortality. This study maps trials in cancer screening, prevention and early diagnosis (SPED) to identify areas of unmet need and highlight research priorities. Methods A systematic mapping review was conducted to evaluate all clinical trials focused on cancer SPED, irrespective of tumour type. The National Cancer Research Institute (NCRI) portfolio, EMBASE, PubMed and Medline were searched for relevant papers published between 01/01/2007 and 01/04/2020. References were exported into Covidence software and double-screened. Data were extracted and mapped according to tumour site, geographical location, and intervention type. Results 117,701 abstracts were screened, 5157 full texts reviewed, and 2888 studies included. 1184 (52%) trials focussed on screening, 554 (24%) prevention, 442 (20%) early diagnosis and 85 (4%) a combination. Colorectal, breast and cervical cancer comprised 61% of all studies compared with 6.4% in lung and 1.8% in liver cancer. The latter two are responsible for 26.3% of global cancer deaths compared with 19.3% for the former three. Number of studies varied markedly according to geographical location; 88% were based in North America, Europe or Asia. Conclusions This study shows clear disparities in the volume of research conducted across different tumour types and according to geographical location. These findings will help drive future research effort so that resources can be directed towards major challenges in cancer SPED.

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