Stage at diagnosis and early mortality from cancer in England

Improving cancer survival is a key challenge identified in ‘Improving outcomes: a strategy for cancer (Department of Health, 2011)'. Cancer survival estimates in England currently fall below those in many European countries across most cancer types (Richards, 2007; Verdecchia et al, 2007; Coleman et al, 2011; De Angelis et al 2014). It has been estimated that if cancer survival in England was made comparable with the European average, then 5000 or more deaths within 5 years of diagnosis could be avoided annually (Abdel-Rahman et al, 2009; Richards 2009a). However, if analyses are restricted to include only those who survive at least a year from diagnosis, then the difference in conditional 5-year survival between England and European countries is, in general, smaller (Thomson and Forman, 2009; Holmberg et al, 2010). This would suggest that differences in 1-year survival are an important driver of differences in longer-term survival. Stage at diagnosis is highly predictive of cancer mortality, and a possible explanation for the difference in cancer survival between England and Europe is that a higher proportion of patients are diagnosed at a later stage in England (Sant et al, 2003; Foot and Harrison, 2011; Walters et al, 2013a, 2013b). The completeness of stage at diagnosis for cancers registered in England by the NCRS has improved greatly in recent years. Staging completeness now exceeds 80% for several major cancers (including breast, colorectal, lung, ovarian and prostate) diagnosed in 2012, allowing more robust analyses than have previously been possible. The remainder of staging data may be missing for various reasons: certain morphological tumour types have no formal agreed staging system; it was clinically inappropriate to stage the patient; diagnosis and/or treatment was outside the National Health Service; the patient died before staging was complete; or staging information was not transferred to the NCRS. In England, a National Awareness and Early Diagnosis Initiative was established in 2008 (Richards, 2009b) as a joint initiative between the Government and Cancer Research UK. Much of its work has focussed on ways of promoting awareness of the early symptoms of cancer to patients and primary-care physicians. The ability to measure stage at diagnosis at a population level is vital to study the impact of such initiatives, study the scale and nature of variation in stage at diagnosis within England and to enable international comparisons. The purpose of this study is to characterise the stage at presentation for major cancers, which have the highest recorded stage completeness, and to examine the relationship between stage at diagnosis, early mortality and major demographic variables.