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ObjectivesCancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders.Design and settingA retrospective secondary data analysis using data from NHS Digital’s National Cancer Registration and Analysis Service and Hospital Episode Statistics records from 2012 to 2016.ParticipantsThis study analysed newly diagnosed breast, colon, non-small cell lung cancer (NSCLC), ovary, prostate and uterine cancers in white British, Caribbean, African, Chinese and Asian patients aged 15–99 in England.ResultsCaribbean, African and Asian women with breast or ovarian cancer, Caribbean and African women with uterine or colon cancer, Caribbean women with NSCLC and Caribbean men with colon cancer had increased odds of late-stage disease at diagnosis compared with the white British cohort. In contrast, Caribbean and African men with prostate cancer had decreased odds of late-stage cancer. Where stage was known, there were variations in late-stage cancer by ethnic group.ConclusionsLow symptom awareness and barriers to presentation can cause delays, resulting in later stage diagnosis. Targeted intervention campaigns to help raise awareness of cancer signs and symptoms and the benefits of early diagnosis, along with removing barriers to appropriate referrals, could help to improve these inequalities.

ImportanceMental health morbidity (MHM) in patients presenting with possible cancer symptoms may be associated with prediagnostic care and time to cancer diagnosis.ObjectiveTo compare the length of intervals to cancer diagnosis by preexisting MHM status in patients who presented with symptoms of as-yet–undiagnosed colon cancer and evaluate their risk of emergency cancer diagnosis.Design, Setting, and ParticipantsThis cohort study was conducted using linked primary care data obtained from the population-based Clinical Practice Research Datalink, which includes primary care practices in England, linked to cancer registry and hospital data. Included participants were 3766 patients diagnosed with colon cancer between 2011 and 2015 presenting with cancer-relevant symptoms up to 24 months before their diagnosis. Data analysis was performed in January 2021 to April 2022.ExposuresMental health conditions recorded in primary care before cancer diagnosis, including anxiety, depression, schizophrenia, bipolar disorder, alcohol addiction, anorexia, and bulimia.Main Outcomes and MeasuresFast-track (also termed 2–week wait) specialist referral for investigations, time to colonoscopy and cancer diagnosis, and risk of emergency cancer diagnosis.ResultsAmong 3766 patients with colon cancer (median [IQR] age, 75 [65-82] years; 1911 [50.7%] women ), 623 patients [16.5%] had preexisting MHM recorded in primary care the year before cancer diagnosis, including 562 patients (14.9%) with preexisting anxiety or depression (accounting for 90.2% of patients with preexisting MHM) and 61 patients (1.6%) with other MHM; 3143 patients (83.5%) did not have MHM. Patients with MHM had records of red-flag symptoms or signs (ie, rectal bleeding, change in bowel habit, or anemia) in the 24 months before cancer diagnosis in a smaller proportion compared with patients without MHM (308 patients [49.4%] vs 1807 patients [57.5%]; P P = .01). Among 2115 patients with red-flag symptoms or signs, 308 patients with MHM experienced a more than 2-fold longer median (IQR) time to cancer diagnosis (326 [75-552] days vs 133 [47-422] days) and higher odds of emergency diagnosis (90 patients [29.2%] vs 327 patients [18.1%]; adjusted OR = 1.63; 95% CI, 1.23-2.24; P Conclusions and RelevanceThis study found that patients with MHM experienced large and prognostically consequential disparities in diagnostic care before a colon cancer diagnosis. These findings suggest that appropriate pathways and follow-up strategies after symptomatic presentation are needed for earlier cancer diagnoses and improved health outcomes in this large patient group.

This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data (N=205,541invitees aged 60–74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (P=0.68). In 60–69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%,OR=1.07,P=0.047). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%,OR=1.09,P=0.027). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%,OR=1.28,P<0.001). The increased uptake in the intervention groups was largest in “first-timers” and smaller amongst previous nonresponders and previously screened invitees.

Background The accessibility of open data means that ever more information is available, and it is important that the public and policy makers are able to make sense of it. Cancer Research UK developed an interactive website that places cancer data in a local context. The aim is to support decision makers and health professionals by highlighting areas for improvement at a local level. In addition to the interactive website, more in-depth analysis of general practice statistics provides general practitioners with better contextualisation of their local population. Methods The interactive website compiles publicly available local data for epidemiology, risk factors, and early diagnosis from a range of sources. Locations can be compared with the national average and with other areas on the basis of statistically significant differences. Local area statistics are also matched to parliamentary constituencies to engage policy makers. Data are converted to intelligence with recommended actions and presented by means of infographics. In addition, to support general practitioners, regression analysis of screening coverage data for general practices linked to practice demographic data provided a model to predict the expected screening coverage. Findings Local statistics show variation in risk factor prevalence and hence cancer burden and outcomes. These data inform evidence-based discussions with politicians as demonstrated by Members of Parliament referencing our analyses during parliamentary debates and in constituency press releases. Our user surveys indicate that 70% of health professionals using the interative website found the content relevant. Modelling of screening data shows that variation in screening coverage across general practices is explained to varying degrees by several patient population characteristics. The difference between the expected and actual coverage identified whether each practice achieved a higher or lower screening coverage than predicted. Users found the results helpful as demonstrated by requests for additional analysis and further partnership working. Interpretation This web resource enables local variations in data to be explored, highlighting the challenges and opportunities for improving outcomes locally, helping to raise cancer awareness, and identifying where action needs to be taken to reduce inequalities. Modelling results communicated with general practitioners face-to-face provides an improved indication of practice screening performance, and supports them in improving early diagnosis. Funding None.