Professor Fiona Walter

Profile

As Director of the Wolfson Institute of Population Health, I am responsible for the strategic leadership of the Institute’s research and education.

I also co-lead the WIPH’s Cancer Detection and Diagnosis Unit with Professor Stephen Duffy. Our objective is to deliver world-class research focusing on the cancer pathway, from prevention, screening, early detection and diagnostics to pre-treatment care; we also focus on translating genetics advances into primary care. I have won research grants totalling more than £35 million in the UK and AU$8 million in Australia, and published over 220 peer-reviewed articles. I co-lead the CanTest Collaborative, Cancer Research UK’s first Catalyst award, aiming to accelerate progress towards improving cancer outcomes by focussing on the transformative implementation in primary care of tests to support early detection of cancer. I am also co-investigator on the £5m NIHR Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, led by Professor Stephen Duffy.

Current UK research leadership roles include membership of Cancer Research UK’s Early Detection and Diagnosis and Clinical Academic Committees. I have an honorary post at the University of Cambridge’s Primary Care Unit in the Department of Public Health and Primary Care and continue to supervise students and completing studies. My international work is marked by an honorary academic role at the University of Melbourne, Australia, where I contribute to parallel programmes of work on improving outcomes for cancer patients. I also co-lead research in South Africa and Zimbabwe with a NIHR Global Research Group ‘Advancing Early Diagnosis of Cancer across Southern Africa, and contribute to research in Europe and the US. My educational and capacity building work is marked by the setting up and delivery of the CanTest International School in Cancer Detection Research in Primary Care.

EA to WIPH Director: Angela Williams

Research

Research Interests:

My research expertise lies across the primary care research spectrum and includes randomised controlled trials, cohort studies and systematic reviews; I have a particular interest in patient experiences and qualitative and mixed methods approaches.

Publications

Please click through to see a complete list of Fiona's publications

Outstanding publications

Aggarwal, A. Choudhury, N. Fernhead, P. Kearns, A. Kirby, M. Lawler, S. Quinlan, C. Palmieri, T. Roques, R. Simcock, F. Walter, P. Price, R. Sullivan. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol 14 Nov 2023 DOI: 10.1016/S1470-2045(23)00511-9

Usher-Smith JA, Hindmarch S, French D, Tischkowitz M, Moorthi S, Walter FM, Dennison R, Stutzin F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Brit J Cancer 2023 May;128(9):1636-1646. DOI:  10.1038/s41416-023-02145-w

Sarma EA, Walter FM, Kobrin SC. Achieving Diagnostic Excellence for Cancer: Symptom Detection as a Partner to Screening. JAMA 2022, Aug 9;328(6):525-526. DOI:  10.1001/jama.2022.11744

Jones OT, Matin RN, van der Schaar M, Prathivadi Bhayankaram K, Ranmuthu CKI, Islam MS, Calanzani N, Emery JD, Williams H, Morris S, Walter FM. Accuracy and safety of AI/ML algorithms which facilitate early detection of skin cancer for use in community and primary care settings – a systematic review. Lancet Digital Health 2022 Jun;4(6):e466-e476. DOI:  10.1016/S2589-7500(22)00023-1

Aggarwal A, Walter FM, Sullivan R, van der Meulen J. “Shopping around” for treatment is not a solution to the cancer backlog. Brit Med J .2022 Oct 10;379:e071967 DOI:  10.1136/bmj-2022-071967

Bailey SER, Abel GAA, Atkins A, Byford R, Davies SJ, Mays J, MacDonald J, Miller J, Neck C, Rennison J, Thomas P, Walter FM, Warren S, Hamilton W. Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England. Brit J Cancer 2021 Mar;124(7):1231-1236. DOI:  10.1038/s41416-020-01221-9

Funston G, Hamilton W, Abel GAA, Crosbie EJ, Rous B, Walter FM. The diagnostic performance of CA125 for the detection of ovarian and non-ovarian cancer in primary care: A population-based cohort study. PLoS Med 2020; 17(10):e1003295. DOI:  10.1371/journal.pmed.1003295

Fitzgerald RC, Di Pietro M, O’Donovan M, Maroni R, Muldrew B, Debiram-Beecham, Gehrung M, Offman J, Tripathi M, Smith S, Aigret B, Walter FM, Rubin G, on behalf of the BEST3 Trial team, Sasieni P. Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. Lancet 2020. DOI:  10.1016/S0140-6736(20)31099-0

Freeman K, Dinnes J, Chuchu N, Takwoingi Y, Bayliss SE, Matin RN, Jain A, Walter FM, Williams HC, Deeks, JJ. Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies. Brit Med J, 2020 Feb 10;368:m127. DOI:  10.1136/bmj.m127

Walter FM, Thompson MJ, Wellwood I, Abel GA, Hamilton W, Johnson M, Lyratzopoulos G, Messenger M, Neal R, Rubin G, Singh H, Spencer A, Sutton S, Vedsted P, Emery JD. Evaluating diagnostic strategies for early detection of cancer in primary care: the CanTest framework. BMC Cancer, 2019;19:586. DOI:  10.1186/s12885-019-5746-6

Lee A, Mavaddat N, Wilcox AN, Cunningham A, Carver T, Hartley S, Babb de Villiers C, Izquierdo A,  Simard J, Schmidt MK,  Walter FM, Garcia-Closas M, Tischkowitz M, Pharoah P, Easton DF, Antoniou AC. BOADICEA: a comprehensive breast cancer risk prediction model incorporating genetic and non-genetic risk factors. Genet Med, 2019 Aug;21(8):1708-1718. Published online 2019 Feb 18. DOI:  10.1038/s41436-018-0406-9

Rubin G, Walter FM, Emery J, de Wit N. Re-imagining the diagnostic pathway for gastro-intestinal cancer. Nature Reviews Gastro Hepat, 2018;15(3):181-188. DOI:  10.1038/nrgastro.2018.1

Walter FM, Mills K, Mendonca S, Abel G, Basu B, Carroll N, Hamilton W, Rubin GP, Emery JD. Symptoms and patient factors associated with diagnostic intervals for pancreatic cancer (SYMPTOM pancreatic study): a prospective cohort study. Lancet Gastroenterol, 2016;1(4):298-306. DOI:  10.1016/S2468-1253(16)30079-6

Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter FM, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol, 2015 Sep;16(12):1231-1272. DOI:  10.1016/S1470-2045(15)00205-3

Banks J, Hollinghurst S, Bigwood L, Peters TJ, Walter FM, Hamilton W. Preferences for cancer investigation: a vignette-based study of primary care attenders. Lancet Oncol, 2014;15(2):232-240. doi: 10.1016/S1470-2045(13)70588-6. DOI:  10.1016/S1470-2045(13)70588-6

Walter FM, Morris HC, Humphrys E, Hall PN, Kinmonth A, Prevost A, Wilson EC, Burrows N, Norris P, Johnson M, Emery J. Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised controlled trial. Brit Med J,

Scott SE, Walter FM, Webster A, Emery JD. The Model of Pathways to Treatment: conceptualization and integration with existing theory. Br J Health Psychol, 2013; 18(1):45-65. DOI:  10.1111/j.2044-8287.2012.02077.x2012;345:e4110. DOI:  10.1136/bmj.e4110

Weller D, Vedsted P, Rubin G, Walter FM, Emery J, Scott S, Campbell C, Andersen RS, Hamilton W, Olesen F, Rose P, Nafees S, van Rijswijk E, Hiom S, Muth C, Beyer M, Neal RD. The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer, 2012;106(7):1262-126. DOI:  10.1038/bjc.2012.68

Walter FM, Scott SE, Webster A, Emery JD. The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Services Research & Policy 2012;17(2):110-118. DOI:  10.1258/jhsrp.2011.010113

Supervision

Dr Owain Jones, Cancer Research UK. ‘Understanding and implementing technology, artificial intelligence and deep learning to improve melanoma assessment in primary care settings.’

Victoria Hardy, CanTest- Cancer Research UK. ‘Understanding cancer diagnostic pathways for people presenting in primary care with abdominal pain.’

Laura Standen, Barts Charity, ‘Investigating disclosure of subtle cognitive changes when presenting to the GP with a headache’. Start date: Sep 2022)

Stefanie Bonfield, Barts Charity, ‘Understanding public preferences for cancer detection test modalities to improve equitable participation’. Start date: January 2022

Dr Sarah Moore, University of Exeter. ‘How would the refinement of urgent cancer referral criteria, by the inclusion of a broader set of variables available in primary care health records, affect numbers of patients eligible for referral and their outcomes?’