E-poster Presentation 2014 World Cancer Congress

Routes to Diagnosis: Does it matter when or how a cancer is diagnosed? (#659)

Sam Johnson 1 , Sean McPhail 1 , Lucy E Elliss-Brookes 1 , Matt Greenslade 2 , Alex Ives 2 , Jon Shelton 1
  1. National Cancer Intelligence Network, Public Health England, London, United Kingdom
  2. Knowledge & Intelligence Team (South West), Public Health England, Bristol, United Kingdom


Cancer survival in England is lower than the European average, which has been partly attributed to later stage at diagnosis.  The Routes to Diagnosis study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis.


Initial results have been expanded to cover a greater number of cancer sites.  Presentation by day of the week is examined as well as how the proportion of Emergency Presentations (EPs) changes over time.


Administrative hospital patient episodes data are combined with Cancer Waiting Times, cancer screening and cancer registration data. The method uses the diagnosis date as an end-point and then works backwards to identify the likely referral route. Every case of cancer diagnosed in England in 2006-2010 (1,272,584 cases) is categorised into one of 8 Routes to Diagnosis.


EPs fell from 24% in 2006 to 22% in 2010, for all cancers combined.  The proportion of Two Week Waits increased from 24% to 30% over the same period.  Results are now available for 57 cancer sites including cancer of unknown primary and selected benign or in-situ tumours, as well as rarer sites such as the salivary glands, nasopharynx and anus. Analysis of EPs by day of week suggests little variation in survival by day of week for colorectal, lung and pancreatic cancers. A smaller proportion of EPs are seen on Saturday and Sunday.


The decline in Emergency presentations and increase in more managed Routes over the five year period is encouraging. Access to more complete data has also helped to reduce the proportion of cancers with unknown Routes. The expansion of cancer sites adds greater value for understanding rare and less common cancers.

  1. Elliss-Brookes L et al. (2012) Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets. BJC 107: 1220-1226