IoS letters, emails and online postings (19 July 2015)

There is no doubt that cancer survival in the UK compares poorly with other European countries, and that this is due to delayed diagnosis (“Call to get radical with cancer tests”, 19 July). However, the problem lies with the late referral of patients to hospital by GPs, who have been incentivised not to make unnecessary referrals. Your article seems to think that the solution is to reduce the time to diagnosis (after referral) from two months to one month by offering GPs access to expensive diagnostic tests. But one month will make very little difference to cancer mortality, and radiology departments will be swamped.

I used to run a melanoma referral service for South East Thames and repeatedly encountered patients who had been wrongly reassured that their changing mole was nothing to worry about, sometimes six months or even a year before referral. This type of delay does make a difference. There are approximately 11,000 new melanomas a year in the UK and slightly fewer than 44,000 GPs, so on average a GP will see a melanoma once every four years.

There is no clever test to diagnose melanoma other than excision of the lesion in a centre equipped to make the right diagnosis histologically. Yet melanoma mortality in the UK compares poorly with countries such as Australia where GPs see many more cases and have a lower threshold for referral. The solution lies in better education of GPs when to refer, and a system that does not financially discourage them from doing so. Devolving responsibility for cancer diagnosis to primary care will simply make a bad situation worse.

Dr Robin Russell-Jones

Stoke Poges, Buckinghamshire

I was shocked by the line taken in your leader on the images of members of the Royal Family giving a Nazi salute (“The Queen has earned her privacy”, 19 July).

The Windsors had German relatives, some of whom were Nazis; one such was the Duke of Coburg, who, according to the historian Karina Urbach, was taken by Elizabeth, then Duchess of York, round the gardens at Sandringham in 1933.

The Royal Family are quite capable of protecting their privacy without help; when Dr Urbach visited the royal archive for research on her book Go-Betweens for Hitler, she was denied access to letters from the Windsors’ German relatives.

John Dakin

Dunstable, Bedfordshire

I do find it irritating when a woman of vast inherited wealth, who has lived a life of barely imaginable privilege and comfort, and even has political power by right of birth, is referred to as having “served her country selflessly all her life”.

Robert Littlestone

Loughton, Essex

Wouldn’t it be nice if we could be mature enough to accept that not everyone is cut out for parenthood (“No children, no problem”, 19 July). Joan Smith made me feel this wasn’t such a lonely trail to plod, after all.

Jennifer Lamport

South Croydon

Your article “This Budget cut will deepen our plight” (12 July) fails to reflect the support that is available. Employment and support allowance (ESA) is the benefit paid to those who cannot work, and the vast majority of those with cancer who apply are placed in the “support group”. These individuals receive the highest rate of the benefit and will continue to do so. There has been no change to this component, and those eligible will continue to receive up to £109.30 a week. The vast majority of people claiming ESA with cancer get this rate. This includes anyone who is preparing for, receiving or recovering from chemotherapy or radiotherapy which will significantly limit their ability to work.

You neglected to mention that there will be no cash losses for those already claiming ESA (in the “work-related activity group”). The change, intended to return fairness to the system for those who are able to work in the future, will apply only to new claims from April 2017 at the earliest. People facing a cancer diagnosis, and their families, will continue to get the support they need.

Priti Patel

Minister for Employment London SW1