The National Cancer Plan sets out an ambitious programme to transform cancer outcomes through earlier diagnosis, personalised risk assessment, and rapid adoption of innovation within the NHS.
Blood-based biomarkers, dynamic cancer risk profiling, and technologies capable of detecting multiple cancers are central to this vision.
HELP Flag is a novel, NHS-embedded diagnostic innovation that directly addresses these priorities by identifying patients at risk of multiple cancers using routinely collected blood test results. Implemented through a highly effective partnership between academia, the NHS, and the Cancer Alliance, HELP Flag demonstrates how academic innovation can directly address policy objectives at scale.
This article outlines how HELP Flag aligns with key elements of the National Cancer Plan.
The National Cancer Plan and the case for change
Despite major advances in cancer care, late diagnosis remains a critical driver of poor outcomes. The National Cancer Plan responds to this challenge by prioritising early diagnosis and reducing emergency presentations of cancer, and narrowing persistent health inequalities. Central to this strategy is a shift towards individualised cancer risk assessment, greater use of blood-based biomarkers, and a ‘big leap’ in reinventing the early diagnosis pathway through dynamic risk profiling.
Alongside these ambitions, the Plan commits to substantial system investment: 9.5 million additional diagnostic tests and £2.3 billion in diagnostics funding, while emphasising the need for innovation that is scalable, cost-effective, and rapidly implementable within existing NHS infrastructure.
HELP Flag has been developed precisely within this context.
HELP Flag: individual cancer risk profiling using routine full blood count results
HELP Flag is an innovative clinical decision support approach that identifies patients at risk of multiple cancers using routinely available full blood count results. Rather than introducing a new test or biomarker, HELP Flag uses existing test results more intelligently, applying personalised risk thresholds to generate a dynamic cancer risk profile.
This approach directly addresses the National Cancer Plan’s emphasis on:
By signalling elevated cancer risk earlier in the diagnostic journey, HELP Flag creates an opportunity for timely investigation before symptoms escalate or emergency presentation occurs.
Patient-supported technology
The Cancer Plan explicitly calls for a ‘big leap’ in early diagnosis and giving patients more control and insights into their cancer risk profile. This in itself has the potential to come with some harm and risk, including anxiety and alarm in patients seeing their risk profiles. HELP Flag has been shaped by extensive public and patient involvement and engagement. Our innovative patient engagement strategy has ensured that our public contributors have been with us since the very start, supporting our progress and shaping how patients are informed of their risk and results. Our public contributors have been instrumental in encouraging the development of HELP Flag and continue to play a vital role in ensuring that risk communication is acceptable, ethical, and appropriate for all. One public contributor reflected on how ‘from a patient’s point of view, its crucial that the system feels like a helping hand, and not a red flag.’
Reducing emergency presentations and increasing early-stage diagnosis
Reducing emergency presentation and increasing stage I and II diagnosis remains a central priority for cancer care. HELP Flag holds particular promise in this area. In an unpublished audit, we examined the anonymised records of patients who would have qualified for a HELP Flag. Half of those who were not picked up by existing suspected cancer pathways had an emergency presentation. That finding really highlighted a critical missed opportunity in current pathways and underscores the potential of HELP Flag to support earlier intervention and avoidance of the emergency presentation. If HELP Flag were active at the time those diagnoses were made, the patients may have avoided that emergency presentation.
Our ongoing HELP Flag evaluation, funded by the NHSE Cancer Innovation programme, will quantify the impact on stage at diagnosis and emergency presentation. Early evidence does suggest that systematic identification of raised cancer risk through routine blood tests could substantially reduce emergency presentations – one of the most resource intensive and prognostically unfavourable routes to diagnosis.
Addressing health inequalities
The National Cancer Plan places strong emphasis on narrowing health inequalities, recognising that late diagnosis disproportionately affects underserved populations. Our HELP Flag study explicitly incorporates an inequality assessment and includes planned evaluation of its impact across socio-demographic groups. By using routine blood tests already taken across the population, HELP Flag has the potential to reduce inequalities inherent in access-dependent diagnostic pathways. However, this approach relies on patient access to full blood counts and to primary care appointments; our HELP Flag evaluation will tell us more about the scale of this problem and how we can mitigate any risks. In the HELP Flag team, our diverse group of public contributors from two distinctly different regions, share insights that bring the lived experiences of health inequity to life, and strongly advocate for communities affected and emphasising the important role targeted community engagement plays.
Cost effectiveness and system value
While the scale of investment in diagnostics outlined in the National Cancer Plan is substantial, HELP Flag offers a complementary and potentially cost-saving approach. By using existing test results rather than introducing new diagnostics, streamlining and standardising clinical responses to abnormal test results, and potentially reducing emergency presentation, HELP Flag maximises the return on existing NHS resource use. HELP Flag’s low marginal cost and system-level efficiency make it particularly attractive in a constrained financial environment.
From evidence to implementation
One of the National Cancer Plan’s six research priorities is the development of screening and diagnostic tools capable of detecting multiple cancers. HELP Flag directly meets this priority; lung, colorectal, stomach, and endometrial are likely sites of malignancy in HELP Flagged patients.
Furthermore, the Plan commits to speeding up implementation of proven cancer innovations. By the conclusion of our current HELP Flag evaluation in June 2027, the magnitude of HELP Flag’s benefit will be precisely quantified, in terms of clinical impact, cost effectiveness, and patient and clinician acceptability. In addition to the current evidence to support our approach, HELP Flag will be well positioned as an innovation ready for wider adoption across the NHS and beyond.
Summary
HELP Flag is a practical, scalable, and policy-aligned innovation that directly supports the National Cancer Plan’s ambitions for earlier diagnosis, personalised risk assessment, and multi-cancer detection. As our ongoing evaluation continues, the evidence to support the wider implementation of HELP Flag is building. Investment in HELP Flag offers the NHS, policy makers, and industry partners a timely opportunity to accelerate delivery of the National Cancer Plan objectives, while generating evidence for sustainable, system-wide impact.
HELP Flag is led by Associate Professors Sarah Bailey and Dawn Lee at the University of Exeter. For more information, please get in touch via helpflag@exeter.ac.uk
