You’re reading the fifth article in our Health Inequalities Series. It’s part of our ongoing investigation into how inequalities impact every aspect of cancer, from why people get it to how research contributes to helping them.
Today, we’re taking a closer look at early diagnosis. We spoke to Bernard Rachet, Professor of Cancer Epidemiology and leader of the Inequalities in Cancer Outcomes Network (ICON) at the London School of Hygiene & Tropical Medicine, about why some cancers, and some groups of people, tend to be diagnosed later. We’ve also scrutinised the evidence to see how we can make sure more people affected by cancer can be diagnosed early, whoever they may be.
The statistics referenced throughout this article are for England unless otherwise stated, due to limited data availability for routes to diagnosis across other UK nations. The stage at diagnosis isn’t available for every cancer case, so the statistics presented for stage at diagnosis are for those with a known stage.
What is early diagnosis? Who gets it?
The earlier a cancer is diagnosed, the more options we have for treating it, and the better people’s outcomes are likely to be. But some people are less likely to get an early diagnosis than others.
Who is more likely to be diagnosed later, and why they face delays, are complex questions with many possible answers. We know certain cancer types are more likely to be diagnosed at particular stages, but personal characteristics, such as deprivation and ethnicity, also seem to play a part.
Let’s start with cancer types. Testicular cancer has one of the highest proportions of people diagnosed early (at stage 1 or 2) at 91%. This has a big impact. Survival for testicular cancer is related to stage of the disease at diagnosis, coupled with the fact we have very effective treatments for it. Around 95% of people diagnosed with testicular cancer will survive their disease for at least 5 years after their diagnosis.
Compare that to oesophageal cancer, which has the lowest percentage of early diagnoses, just 19%. Almost two-thirds (63%) of people diagnosed with oesophageal cancer in England at the earliest stage will survive their disease for 5 years or longer. But, because so few cases of oesophageal cancer are detected early, only 18% of all people diagnosed with it survive their disease for 5 years or more.
That’s a striking comparison. It helps show the value of early diagnosis. But it doesn’t tell the whole story.
We now know that, for some cancer types, people from an ethnic minority background are more likely to be diagnosed at a later stage than White people.
And, overall, people from more deprived populations in England are more likely to be diagnosed with advanced cancers.
That’s a key reason why people from some demographic groups have worse cancer survival. It’s a problem that needs to be fixed.
In fact, reducing inequalities is one of the most important things we can do to make sure more cancers are diagnosed early. Making diagnosis fairer helps everyone. So, how do we do it?
This article is a step towards answering that question. We’re going to delve into how people are diagnosed with cancer and look at why this varies across different groups. With a better understanding of why some people are more likely to be diagnosed at a late stage, we can start developing ways to catch their cancers sooner.
How are people diagnosed with cancer, and why does this matter?
There are multiple ‘routes’ to a cancer diagnosis. People can be diagnosed after screening, following a GP referral, as an inpatient or outpatient in hospital, or after an emergency presentation, such as at A&E.
The data from England and Northern Ireland tell us that a person is more likely to be diagnosed at a late stage if they present as an emergency compared to other routes.
As shown by the graphic below, in England in 2018, 90% of cancers found via screening were diagnosed at an early stage. The same was true of only 25% of cancers detected after an emergency presentation.