Abstract
BackgroundStage at diagnosis strongly predicts cancer survival and understanding related inequalities could guide interventions.MethodsWe analysed incident cases diagnosed with 10 solid tumours included in the UK government target of 75% of patients diagnosed in TNM stage I/II by 2028. We examined socio-demographic differences in diagnosis at stage III/IV vs. I/II. Multiple imputation was used for missing stage at diagnosis (9% of tumours).ResultsOf the 202,001 cases, 57% were diagnosed in stage I/II (an absolute 18% ‘gap’ from the 75% target). The likelihood of diagnosis at stage III/IV increased in older age, though variably by cancer site, being strongest for prostate and endometrial cancer. Increasing level of deprivation was associated with advanced stage at diagnosis for all sites except lung and renal cancer. There were, inconsistent in direction, sex inequalities for four cancers. Eliminating socio-demographic inequalities would translate to 61% of patients with the 10 studied cancers being diagnosed at stage I/II, reducing the gap from target to 14%.ConclusionsPotential elimination of socio-demographic inequalities in stage at diagnosis would make a substantial, though partial, contribution to achieving stage shift targets. Earlier diagnosis strategies should additionally focus on the whole population and not only the high-risk socio-demographic groups.
Highlights
Stage at diagnosis strongly predicts cancer survival and understanding related inequalities could guide interventions
1234567890();,: METHODS Data Data were analysed on incident cases aged 30–99 years diagnosed in 2015 with colon [International Classification of Diseases, Tenth Revision: C18], rectal [C19–C20], lung [C33–C34], melanoma [C43], breast [C50], uterine [C54], ovarian [C56], prostate [C61], renal [C64], and bladder [C67] cancer registered in the English population-based cancer registry run by the Public Health England National Cancer Registration and Analysis Service
As associations between socio-demographic variables and stage at diagnosis could vary by cancer site, in a second model stratified by cancer site (Model 2) we described socio-demographic differences in stage at diagnosis for each studied site separately
Summary
Stage at diagnosis strongly predicts cancer survival and understanding related inequalities could guide interventions. METHODS: We analysed incident cases diagnosed with 10 solid tumours included in the UK government target of 75% of patients diagnosed in TNM stage I/II by 2028. Eliminating socio-demographic inequalities would translate to 61% of patients with the 10 studied cancers being diagnosed at stage I/II, reducing the gap from target to 14%. In 2018, the UK Government has set out a target for 75% of cancer patients with common solid tumours to be diagnosed in tumour, node, metastasis (TNM) stage I or II by 2028.6 how improvements in stage distribution could be achieved within a decade remains uncertain. An appealing strategy to help improve the stage distribution of incident cases is the reduction of stage inequalities by socio-demographic groups. Several demographic and psychosocial factors are associated with the length of time from symptom onset to presentation (i.e. the ‘patient interval’7), and related markers (such as awareness of cancer symptoms or reported psychological or practical barriers to presentation).[8,9] older and lower socioeconomic status individuals tend to have lower awareness of likely cancer symptoms, higher degree of practical or emotional barriers to presentation and help-seeking and to experience longer intervals to diagnosis.[8,9] Socio-demographic differences in stage at diagnosis are likely even in populations served by healthcare systems without financial barriers to accessing care, though such associations may vary between different cancer sites
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
