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BackgroundDifferential uptake of prostate-specific antigen testing in the US and UK has been linked to between-country differences for prostate cancer incidence. We examined stage-specificfatalprostate cancer incidence trends in the US and England, by treatment and race/ethnicity.MethodsUsing data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and Public Health England’s National Cancer Registration and Analysis Service, we identified prostate cancer patients diagnosed between 1995 and 2005, aged 45–84 years. Fatal prostate cancer was defined as death attributed to the disease within 10 years of diagnosis. We used age–period–cohort models to assess trends in fatal prostate cancer incidence.ResultsFatal prostate cancer incidence declined in the US by −7.5% each year and increased in England by 7.7% annually. These trends were primarily driven by locoregional disease in the US and distant disease in England. Black men in both countries had twofold to threefold higher fatal prostate cancer incidence rates, when compared with their white counterparts; however, receipt of radical prostatectomy lessened this disparity.ConclusionsWe report a significant increasing rate of fatal prostate cancer incidence among English men. The black–white racial disparity appears pervasive but is attenuated among those who received radical prostatectomy in the US.

Background Diagnostic timeliness in cancer patients is important for clinical outcomes and patient satisfaction but, to-date, continuous monitoring of diagnostic intervals in nationwide incident cohorts has been impossible in England. Methods We developed a new methodology for measuring the secondary care diagnostic interval (SCDI - first relevant secondary care contact to diagnosis) using linked cancer registration and healthcare utilisation data. Using this method, we subsequently examined diagnostic timeliness in colorectal and lung cancer patients (2014–15) by socio-demographic characteristics, diagnostic route and stage at diagnosis. Results The approach assigned SCDIs to 94.4% of all incident colorectal cancer cases [median length (90th centile) of 25 (104) days] and 95.3% of lung cancer cases [36 (144) days]. Advanced stage patients had shorter intervals (median, colorectal: stage 1 vs 4 - 34 vs 19 days; lung stage 1&2 vs 3B&4 - 70 vs 27 days). Routinely referred patients had the longest (colorectal: 61, lung: 69 days) and emergency presenters the shortest intervals (colorectal: 3, lung: 14 days). Comorbidities and additional diagnostic tests were also associated with longer intervals. Conclusion This new method can enable repeatable nationwide measurement of cancer diagnostic timeliness in England and identifies actionable variation to inform early diagnosis interventions and target future research.

BackgroundLung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.MethodsAn early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008–2010) and the three most recent years for which data are available during the campaign (2013–2015).FindingsCommunity-ordered chest X-ray rates per year increased from 18 909 in 2008–2010 to 34 194 in 2013–2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, pInterpretationThis is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

Background The National Cancer Registration and Analysis Service (NCRAS), in Public Health England (PHE), collects and quality assures clinical information on all cases of cancer that occur in people living in England. The data collected supports the delivery of effective NHS cancer services. Aim NCRAS aims to curate a clinically rich data resource, which this abstract describes. Approach The data collected by NCRAS comes from several sources including Multi-Disciplinary Team (MDT) meetings and pathology reports. Data is reviewed by Cancer Registration Officers with the assistance of automated tools for data linkage and de-duplication of identical data sources. The data collected includes: patient identifiers; patient characteristics (e.g. sex, ethnicity); cancer specific fields (e.g. diagnosis date, cancer site, morphology, laterality, stage at diagnosis); cancer treatment fields; death information (e.g. date and cause of death); health care system information (e.g. hospital of diagnosis); and geography at diagnosis (based on patient’s postcode of residence). Results Data is submitted by 162 healthcare providers, covering over 1,700 MDTs. Population-based official statistics are available for cancers diagnosed since 1971. The data is routinely used to inform and allow evidence-based decisions about NHS service provision and patient care and to longitudinally track cancer incidence rates and survival statistics. In recent years, completeness of specific items such as stage has greatly improved. However, non-death outcomes, such as quality of life assessments and recurrence, are currently difficult to identify. Conclusion Detailed clinical information on cancer across the patient pathway enables the measurement of the diagnosis, treatment and survival outcome of all patients diagnosed with cancer. This population-based national data resource is critical to support service provision, clinical audit, commissioning, planning of services, public health and epidemiological research; all of which contribute to improved outcomes for people diagnosed with cancer.

BACKGROUND: In the re-organisation of cancer registration in England in 2012, a high priority was given to the recording of cancer stage and other prognostic clinical data items.METHODS: We extracted 86 852 breast cancer records for women resident in England and diagnosed during 2012-2013. Information on age, ethnicity, socio-economic status, comorbidity, tumour stage, grade, morphology and oestrogen, progesterone and HER2 receptor status was included. The two-year cumulative risk of death from any cause was estimated with the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regressions were used to estimate hazard ratios (HR) and their 95% confidence intervals (95% CI). The follow-up ended on 31 December 2014.RESULTS: The completeness of registration for prognostic variables was generally high (around 80% or higher), but it was low for progesterone receptor status (41%). Women with negative receptor status for each of the oestrogen, progesterone and HER2 receptors (triple-negative cancers) had an adjusted HR for death of 2.00 (95%CI 1.84-2.17). Black women had an age-adjusted HR of 1.77 (1.48-2.13) compared with White women.CONCLUSIONS: The excess mortality of Black women with breast cancer has contributions from socio-economic factors, stage distribution and tumour biology. The study illustrates the richness of detail in the national cancer registration data. This allows for analysis of cancer outcomes at a high level of resolution, and may form the basis for risk stratification.British Journal of Cancer advance online publication, 25 October 2016; doi:10.1038/bjc.2016.335 www.bjcancer.com.

Background: Differential uptake of prostate-specific antigen (PSA) testing in the US and UK has been linked to between-country differences in prostate cancer incidence. In the US, men of African ancestry have been shown to have a higher incidence of prostate cancer that is ultimately fatal compared with men of European ancestry, thus prompting calls for precision prevention approaches to screening. To assess whether temporal and racial differences are evident in the UK, we assessed the incidence of fatal prostate cancer in the US and England during a period of evolving screening recommendations and practices in both countries. Methods: Using data from the Surveillance, Epidemiology, and End Results program and Public Health England's National Cancer Registration and Analysis Service, we identified prostate cancer patients newly diagnosed between 1995 and 2005, aged 45-84 years old. We defined fatal prostate cancer as death attributed to the disease within 10 years of diagnosis. To evaluate incidence trends across the 11-year study period, we used age-period-cohort modeling to calculate estimated annual percentage change (EAPC) and joinpoint regression analysis to identify periods of significant change. Results: In the US, 9% (n=38,409) of the 429,541 prostate cancer cases were fatal, compared with 17% (n=39,249) of the 228,615 cases in England. The age-adjusted incidence of fatal prostate cancer declined in the US by -4.2% per year (95%CI: -4.6%, -3.8%) and increased in England by 7.7% per year (95%CI:7.2%, 8.3%). From 2002-2005, the US experienced a more rapid decline in the incidence of fatal disease (EAPC = -6.4%; 95%CI: -8.3%, -4.5%) while rates in England continued to increase, albeit to a lesser degree (EAPC = 4.3%; 95%CI: -0.1%, 8.9%). Temporal trends for each country did not differ by race. However, a black-to-white difference persisted across the study period, with black men in both the US and England experiencing 2-to-3-fold higher incidence rates of fatal prostate cancer compared with white men. Conclusions: During a period of increased PSA testing in the US and relatively low, but growing, use in England, we observed opposing trends for the incidence of fatal prostate cancer between the two countries. Our ecological study suggests that country-specific screening practices may influence temporal trends for the incidence of fatal prostate cancer similarly for black and white men, though a disparity persists in the absolute rate of disease occurrence between the two groups. Citation Format: Eboneé N. Butler, Scott P. Kelly, Victoria H. Coupland, Philip R. Rosenberg, Michael B. Cook. Racial differences in the incidence of fatal prostate cancer in two countries: An ecological comparison of the United States and England [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C016.

PurposeThe linked prescriptions cancer registry data resource was set up to extend our understanding of the pathway for patients with cancer past secondary care into the community, to ultimately improve patient outcomes.ParticipantsThe linked prescriptions cancer registry data resource is currently available for April to July 2015, for all patients diagnosed with cancer in England with a dispensed prescription in that time frame.The dispensed prescriptions data are collected by National Health Service (NHS) Prescription Services, and the cancer registry data are processed by Public Health England. All data are routine healthcare data, used for secondary purposes, linked using a pseudonymised version of the patient’s NHS number and date of birth.Detailed demographic and clinical information on the type of cancer diagnosed and treatment is collected by the cancer registry. The dispensed prescriptions data contain basic demographic information, geography measures of the dispensed prescription, drug information (quantity, strength and presentation), cost of the drug and the date that the dispensed prescription was submitted to NHS Business Services Authority.Findings to dateFindings include a study of end of life prescribing in the community among patients with cancer, an investigation of repeat prescriptions to derive measures of prior morbidity status in patients with cancer and studies of prescription activity surrounding the date of cancer diagnosis.Future plansThis English linked resource could be used for cancer epidemiological studies of diagnostic pathways, health outcomes and inequalities; to establish primary care comorbidity indices and for guideline concordance studies of treatment, particularly hormonal therapy, as a major treatment modality for breast and prostate cancer which has been largely delivered in the community setting for a number of years.

IntroductionLung cancer outcomes in England are inferior to comparable countries. Patient or disease characteristics, healthcare-seeking behaviour, diagnostic pathways, and oncology service provision may contribute. We aimed to quantify associations between geographic variations in treatment and survival of patients in England.MethodsWe retrieved detailed cancer registration data to analyse the variation in survival of 176,225 lung cancer patients, diagnosed 2010-2014. We used Kaplan-Meier analysis and Cox proportional hazards regression to investigate survival in the two-year period following diagnosis.ResultsSurvival improved over the period studied. The use of active treatment varied between geographical areas, with inter-quintile ranges of 9%–17% for surgical resection, 4%–13% for radical radiotherapy, and 22%–35% for chemotherapy. At 2 years, there were 188 potentially avoidable deaths annually for surgical resection, and 373 for radical radiotherapy, if all treated proportions were the same as in the highest quintiles. At the 6 month time-point, 318 deaths per year could be postponed if chemotherapy use for all patients was as in the highest quintile. The results were robust to statistical adjustments for age, sex, socio-economic status, performance status and co-morbidity.ConclusionThe extent of use of different treatment modalities varies between geographical areas in England. These variations are not attributable to measurable patient and tumour characteristics, and more likely reflect differences in clinical management between local multi-disciplinary teams. The data suggest improvement over time, but there is potential for further survival gains if the use of active treatments in all areas could be increased towards the highest current regional rates.

IntroductionThe International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome.MethodsLinked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons.ResultsIt was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable.ConclusionThe results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required.

Rationale, aims and objectives Primary liver cancer consists of distinct subtypes with differing aetiology so it is valuable to study the incidence of these subtypes separately. This study aims to investigate time and socio-economic deprivation trends in the incidence of primary liver cancer subtypes in England, identifying the burden in the population. Methods Data were extracted from the population-based National Cancer Data Repository (NCDR) for patients diagnosed with primary liver cancer between 1990 and 2009. Subtypes were defined by the 10th edition of the International Classification of Diseases (ICD-10) codes: liver cell carcinoma (C22.0), intrahepatic bile duct carcinoma (C22.1), other (C22.2–C22.4, C22.7) and unspecified (C22.9). A sensitivity analysis was carried out on the main histological subtypes of liver cell carcinoma and intrahepatic bile duct using the 2nd edition of the International Classification of Diseases for Oncology (ICD-O-2). Male and female age-standardized incidence rates per 100 000 World standard population were calculated for each year and for the period 1999–2009 by socio-economic deprivation quintile. Results A total of 40 945 patients were diagnosed with primary liver cancer between 1990 and 2009. Liver cell carcinoma incidence increased in men from 0.63 in 1990 to 2.48 per 100 000 in 2009. While incidence was low in women, rates increased from 0.18 to 0.59, respectively. Intrahepatic bile duct carcinoma incidence increased between 1990 and 2009 from 0.40 to 1.25 per 100 000 in men, and from 0.28 to 1.08 in women. Incidence of the other liver cancer subtype remained low throughout the study period at less than 0.3 per 100 000 in each year in both men and women. The highest rate of liver cell carcinoma and intrahepatic bile duct carcinoma was generally in men and women resident in the most deprived areas between 1999 and 2009. The largest difference by deprivation quintile was observed for liver cell carcinoma in men, where the incidence was more than double in the most deprived quintile with an average rate of 3.56 per 100 000 compared to the least deprived quintile at 1.43. Conclusions Liver cell carcinoma and intrahepatic bile duct carcinoma incidence increased between 1990 and 2009 in both sexes. This pattern was largely driven by patients living in the most deprived areas. Differences observed may be due to the variation in the prevalence of known risk factors such as chronic hepatitis B and C viral infections and excessive alcohol consumption.

Purpose Studies have reported an association between hospital volume and survival for non–small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect. Methods We analyzed data on 134,293 patients with NSCLC diagnosed in England between 2004 and 2008, of whom 12,862 (9.6%) underwent surgical resection. Hospital volume was defined according to number of patients with resected lung cancer in each hospital in each year of diagnosis. We calculated hazard ratios (HRs) for death in three predefined periods according to hospital volume, sex, age, socioeconomic deprivation, comorbidity, and propensity to resect. Results There was increased survival in hospitals performing > 150 surgical resections compared with those carrying out < 70 (HR, 0.78; 95% CI, 0.67 to 0.90; Ptrend < .01). The association between hospital volume and survival was present in all three periods of follow-up, but the magnitude of association was greatest in the early postoperative period. Conclusion High-volume hospitals have higher resection rates and perform surgery among patients who are older, have lower socioeconomic status, and have more comorbidities; despite this, they achieve better survival, most notably in the early postoperative period.

Dysplasia grading is widely used to assess risk of transformation in oral potentially malignant disorders despite limited data on predictive value. DNA ploidy analysis has been proposed as an alternative. This study examines the prognostic value for both tests used in a routine diagnostic setting to inform clinical management. A retrospective study of conventional dysplasia grading was conducted on 1,401 patients. DNA ploidy analysis was conducted on a subset of 273 patients and results correlated with clinical information, pathologic diagnosis, and outcome over 5 to 15 years. Malignant transformation occurred in 32 of 273 patients (12%) and, of these, 20 (63%) of preexisting index lesions were aneuploid. Of 241 patients not developing carcinoma, only 39 (16%) of index lesions were aneuploid. Epithelial dysplasia correlated with DNA ploidy status (P < 0.001). The overall positive predictive value for malignant transformation by DNA aneuploidy was 38.5% (sensitivity 65.2% and specificity 75%) and by severe dysplasia grade 39.5% (sensitivity 30% and specificity 98%). DNA diploid and tetraploid status had negative predictive value of 90% to 96%. Combining DNA ploidy analysis with dysplasia grading gives a higher predictive value than either technique alone. Each of three traditional dysplasia grades predicts a significantly different risk of carcinoma development and time to transformation. DNA ploidy analysis had equivalent predictive value and also detected additional risk lesions in the absence of dysplasia. Cancer Prev Res; 6(8); 822–31. ©2013 AACR.

We investigated socioeconomic and ethnic inequalities in screen-detected breast cancer in London-a city with relatively low breast cancer screening uptake and a diverse population.Data on 11 957 breast cancers in London women aged 50-64 between 1998 and 2005 were extracted from the Thames Cancer Registry. We investigated the relationship between socioeconomic deprivation and the incidence and 5-year relative survival of screen-detected and non screen-detected cancers. Using logistic regression analysis we explored whether differences in screen-detected cancers between White, Asian and Black women were influenced by age and socioeconomic deprivation.The incidence of screen-detected breast cancer was lower in deprived women and their 5-year relative survival was worse than affluent women. However, survival differences were smaller for screen-detected disease. Among women with breast cancer the odds ratios (OR) for screen-detected disease differed between ethnic groups and these differences were not influenced by adjustment for age and deprivation. Compared with White women, Indian women had higher odds (OR 1.50, 95% confidence interval (1.23-1.84)], and Black Caribbean [0.68 (0.54-0.87)] and Black African women [0.53 (0.38-0.76)] significantly lower odds.A sustained focus on increasing screening uptake among deprived women and in Black communities could decrease inequalities in early diagnosis.

This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England.62,811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery:30, 30-365, and365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients.Increasing hospital volume was associated with lower mortality (p trend=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (p trend0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (p trend=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (p trend0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile).With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.

BACKGROUND: This study investigated the variation in incidence of all, and six subgroups of, oesophageal and gastric cancer between ethnic groups.METHODS: Data on all oesophageal and gastric cancer patients diagnosed between 2001 and 2007 in England were analysed. Self-assigned ethnicity from the Hospital Episode Statistics dataset was used. Male and female age-standardised incidence rate ratios (IRRs) were calculated for each ethnic group, using White groups as the references.RESULTS: Ethnicity information was available for 83% of patients (76 130/92 205). White men had a higher incidence of oesophageal cancer, with IRR for the other ethnic groups ranging from 0.17 95% confidence interval (CI) (0.15-0.20) (Pakistani men) to 0.58 95% CI (0.50-0.67) (Black Caribbean men). Compared with White women, Bangladeshi women (IRR 2.02 (1.24-3.29)) had a higher incidence of oesophageal cancer. For gastric cancer, Black Caribbean men (1.39 (1.22-1.60)) and women (1.57 (1.28-1.92)) had a higher incidence compared with their White counterparts. In the subgroup analysis, White men had a higher incidence of lower oesophageal and gastric cardia cancer compared with the other ethnic groups studied. Bangladeshi women (3.10 (1.60-6.00)) had a higher incidence of upper and middle oesophageal cancer compared with White women.CONCLUSION: Substantial ethnic differences in the incidence of oesophageal and gastric cancer were found. Further research into differences in exposures to risk factors between ethnic groups could elucidate why the observed variation in incidence exists. British Journal of Cancer (2012) 107, 1908-1914. doi:10.1038/bjc.2012.465 www.bjcancer.com Published online 11 October 2012 (C) 2012 Cancer Research UK

Introduction : Hepatic, pancreatic and biliary (HPB) cancers are a group of diverse malignancies managed ideally in specialist centres. This study describes recent patterns in the incidence and survival of HPB cancers in England over a ten year period (1998–2007). Methods : Data on 99,379 English patients (50,656 males; 48,723 females) diagnosed with HPB cancers between 1998 and 2007 were extracted from the National Cancer Data Repository. Data were divided into six site-specific cancer groups; pancreas, ampulla of Vater, biliary tract, primary liver, gallbladder and duodenum. Age-standardised incidence rates (per 100,000 European standard population, (ASR(E))) were calculated for each of the six groups by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan–Meier method. Results : The largest group was pancreatic cancers (63%), followed by primary liver (14%) and biliary cancers (13%). ASR(E) were highest for pancreatic and primary liver cancers whereas cancers of the gallbladder, duodenum and ampulla of Vater had a very low incidence. Over time the incidence of all six groups remained relatively stable, although primary liver cancer increased slightly in males. Incidence rates were higher in males than in females in all groups except gallbladder cancer, and all six groups had a higher incidence in the more deprived quintiles. Overall survival was poor in each of the HPB cancer groups. Conclusions : HPB tumours are uncommon and are associated with poor long term survival reflecting the late stage at presentation. Incidence patterns suggest variable rates linked to socioeconomic deprivation and highlight a male predominance in all sites except the gallbladder. Identification of high risk populations should be emphasised in initiatives to raise awareness and facilitate earlier diagnosis.

We estimated the past and future age-standardised incidence rates of mesothelioma by birth cohort and by period of diagnosis in South East England. We extracted data on patients diagnosed with mesothelioma (International Classification of Diseases-10 C45) between 1960 and 2009 from the Thames Cancer Registry. We calculated the age-standardised incidence rates using the European standard population. We used age-cohort and age-period modelling to estimate the age-specific incidence rates for the 1900 to 1950 birth cohorts and the 1935 to 2034 calendar periods. A much more pronounced increase in mesothelioma incidence between 1972 and 2007 was observed in males than in females. In both sexes, the incidence rates increased in successive generations up to the 1945 birth cohort. Projection of rates in the future showed an increase in incidence in males until 2022 and a decrease thereafter. Among females, the incidence rate was predicted to increase gradually until reaching its maximum around 2027, and to remain stable thereafter. The occurrence of mesothelioma is closely linked to occupational exposure to asbestos in the 1960s and 1970s and, due to the long latency period, the incidence of mesothelioma is projected to increase until the 2020s.

Background Compared with some European countries, England has low lung cancer survival and low use of surgical resection for lung cancer. The use of surgical resection varies within England. We assessed the relationship between surgical resection rate and the survival of lung cancer patients in England. Methods We extracted data on 77,349 non-small cell lung cancer (NSCLC) patients diagnosed between 2004 and 2006 from the English National Cancer Repository Dataset. We calculated the frequency of surgical resection by age, socio-economic deprivation and geographical area. We used Cox regression to compute mortality hazard ratios according to quintiles of frequency of surgical resection amongst all 77,349 lung cancer patients, and separately for the 6900 patients who underwent surgical resection. Results We found large geographical variation in the surgical resection rate for NSCLC in PCT areas (3–18%). A high frequency of resection was strongly inversely associated with overall mortality (HR 0.88, 95% CI 0.86–0.91 for the highest compared to the lowest resection quintile) and only moderately associated with mortality amongst the resected patients (HR 1.15, 95% CI 0.98–1.36). Compared to the highest resection quintile, 5420 deaths could be delayed in the overall NSCLC group, whereas about 146 more deaths could be expected amongst the resected patients. Conclusion The differences in the magnitudes of both the hazard ratios and the absolute excess deaths within resected patients and all NSCLC patients suggests that lung cancer survival in England could plausibly increase if a larger proportion of patients underwent surgical resection. Carefully designed research into the possible benefit of increasing resection rates is indicated.

J Oral Pathol Med (2011) 40: 677–683 Objective: The aims of the study were to determine how frequently oral potentially malignant disorders (OPMDs) transform to cancer and to identify clinical and histological factors determining the rates of transformation. Methods: The study included 1357 patients with biopsy-confirmed OPMDs seen at Guy’s Hospital between 1990 and 1999 and followed up until 2005. The patients’ details (name, date of birth, gender and any other relevant information) were matched to the Thames Cancer Registry (TCR) database and Office for National Statistics (ONS) to identify patients who subsequently developed oral cancer (ICD-10 C00–C06). From each patient’s record, we identified their highest grade of dysplasia, graded as none, mild, moderate or severe. The outcome of principal interest was transformation to oral squamous cell carcinoma. To avoid co-existing malignancies, follow-up was started 6 months after the date of the index biopsy. Kaplan–Meier estimates and Cox proportional hazard analysis were undertaken to explore the factors associated with the time to transformation to oral cancer. Results: One thousand three hundred and fifty-seven patients were included in the study. The majority of patients were women (60.9%), and ∼30% were under 47 years of age. The most common OPMD was lichen planus/lichenoid reaction. Among all OPMDs, 204 (15.1%) had oral epithelial dysplasia (30 severe, 70 moderate and 104 mild). Thirty-five patients developed oral cancer over the follow-up period (2.6%). There was an association between dysplasia grade and time to transformation. Patients with severe dysplasia had a higher risk of transformation to oral cancer [HR 35.4 95% CI (14.2–88.3)] compared to those with no dysplasia. This association remained significant although attenuated [HR 21.6 95% CI (5.8–80.5)] following adjustment for sex, age, anatomical site of OPMD and diagnosis. A significant trend over dysplasia grades was evident (P

Patient surveys are increasingly used to obtain feedback about experiences of care to guide changes in the way services are delivered. We compared the experiences of breast and lung cancer patients at diagnosis, in-patient and outpatient care at a Cancer Centre using a locally adapted version of the Picker Institute Cancer Patient Experience Survey. 65% of breast (82/127) and 65% of lung (75/116) cancer patients responded. Both groups reported good experiences at diagnosis, good support from clinical nurse specialists, and had very positive overall views. Breast patients had slightly poorer experiences of hospital stays while lung patients less often received clinical nurse specialist support and information about other support. Both groups reported that written information was not always provided. 84% (132/157) consented to data on the clinical severity of their condition being used to investigate whether this influenced experiences. This study showed that supportive care policies are being implemented at diagnosis and patients value clinical nurse specialist care. Sufficiently large comparative surveys can identify specific areas of performance for services to focus upon in order to improve quality of care. Patients facing poor prognoses can complete surveys and future studies might explore whether disease stage is associated with differing experiences.

London has a high proportion of hospital deaths, which health policy seeks to reduce. We explore variation and trends in place of death from cancer within London between 2002 and 2007. Mortality data based on death certificates were used to define deaths from cancer at home, hospice, hospital and nursing home and examine trends over time for London. Proportions of deaths in each place were presented in maps for 31 London primary care trusts (PCTs). Funnel plots were used to identify consistent performance outside the control limits of three standard deviations. There was little overall change in place of death for London, but consistent variation between PCTs. Outer London PCTs had higher proportions of home deaths and inner London PCTs higher proportions of hospice deaths. Funnel plots identified consistent high outlying performance for home, hospice and hospital deaths. No PCT showed a change of 10% or more in home deaths, but five showed decreasing hospital deaths and three increasing hospice deaths. Maps and funnel plots appear useful for identifying areas with differing performance for home, hospital, nursing home and hospice deaths. These methods may help further investigation of how local services may successfully support deaths outside hospital.

Population-based studies investigating access to palliative care often use death in a hospice as a proxy for service use. We linked data from a large South London hospice to Thames Cancer Registry (TCR) data to determine whether patients who received hospice services differed from those who did not. We matched hospice data for 2474 cancer patients dying between 2000 and 2006, while resident within a restricted catchment area, to TCR data for residents in this area. During matching 14.2% ( n = 352) of hospice patients were excluded due to differing key dates or addresses. In addition, 5.6% ( n= 175) of residents initially defined as not receiving hospice services were recorded as dying in a hospice in the TCR dataset. The problems of overlapping catchment areas and of defining patients receiving services meant we could not adequately determine use of hospice services. This method might be applied more successfully to non-urban hospices, primary care trusts or larger regions.

BackgroundImprovements in cancer survival have resulted in an increasing population of cancer survivors who are managed in primary care. A partnership was established between the National Cancer Registration and Analysis Service and NHS Business Services Authority to link national cancer registration data to community dispensed prescriptions data.AimWe describe the linkage between these two datasets and the potential value of the resulting data resource.MethodCommunity prescriptions data was collected for April – July 2015 initially. Pseudonymised prescriptions data was supplied to NCRAS for linkage at an individual patient level.Results1.68 million individuals, with a history of cancer and having received a prescription April–July 2015, were identified in both datasets. This was 6% of all individuals prescribed medication in that time. 90,840 patients were newly diagnosed with cancer and had prescriptions in this time period: 90% of all patients diagnosed April–July 2015. Comparison of the two datasets identified data quality issues which must be considered, and these will also be presented.ConclusionThis linked resource has the potential to become largest of its kind and is thus crucial to primary care research. Prescribed medication and its correlation with symptom profiles or co-morbidity at time points relative to diagnosis, will offer unique insights into prescribing patterns and potential associations with earlier diagnosis. Full exploitation of this linked data offers the potential for an evidence base for empowering survivors, updating clinical follow-up guidelines and educating primary care physicians who manage the long-term care of cancer survivors.

Several epidemiological studies have shown an association between the season in which certain cancers are diagnosed and survival, with diagnosis in summer and autumn being associated with better survival. In this study, we have added resolution to the analysis of seasonality in cancer survival by considering mortality within several nonoverlapping time periods following diagnosis, thereby quantifying the separate contributions of mechanisms operating in the short term and in the longer term. We found evidence of seasonality acting on mortality within 2 distinct periods following diagnosis. Diagnosis in the summer was associated with substantially decreased mortality within the first month of diagnosis compared with winter in men with prostate cancer, those of both sexes with colorectal or lung cancer, and most strikingly, amongst women with breast cancer (hazard ratio 0.81 [95% confidence interval 0.75-0.86]). Adjusting for monthly variations in general mortality greatly attenuated the seasonal effects on short-term mortality. At long-term follow-up (>5 years), there was a consistent shift in the seasonality pattern, with autumn diagnosis alone being associated with decreased mortality, both in female breast cancer cases and in lung cancer cases of both sexes. We conclude that the higher survival observed amongst patients diagnosed in summer and autumn is predominantly a short-term phenomenon that is largely attributable to generally higher mortality in winter. However, the distinct mortality reduction observed in the long term amongst those diagnosed in the autumn, especially amongst breast cancer patients, may indicate the presence of a seasonally variable protective mechanism.

Patients diagnosed in 1960-2004 with cancer of the cervix, anus, vulva, vagina or penis were identified from the Thames Cancer Registry database, and age-standardised period (temporal) incidence rates calculated by direct standardisation. Age-cohort modelling techniques were used to estimate age-specific incidence rates in the earlier and later cohorts, enabling the calculation of age-standardised cohort (generational) rates. Incidence of anal cancer increased for both men and women over the period studied, mainly in those born from 1940 onwards. Similar generational patterns were seen for cancers of the vulva and vagina, but those for penile cancer were different. For cervix cancer, the steep downward trend in cohort rates due to screening levelled off in women born from 1940 onwards. Our findings are compatible with the hypothesis that changes in sexual practices were a major contributor to the increases of these cancers. Programmes of vaccination against HPV, aimed at reducing the burden of cervical cancer, may also help to reduce the incidence of cancer at other anogenital sites.

We estimated the future cancer incidence rates and the future numbers of cancer cases in England up to 2020 using cancer registration data for 1974-2003, and the official population projections from ONS up to 2023. Data were analysed using an age-period-cohort model as developed for the Nordic countries. We predict that for all cancers combined there will be relatively little change in age-standardised incidence rates in 2020. The number of new cancer cases per year in England is, however, predicted to increase by 33%, from 224,000 in 2001 to 299,000 cases in 2020. This increase is mainly due to the anticipated effects of population growth and ageing; cancer patients in 2020 will be older than today's cancer population.

Objective: We assessed the association between population resection rates, hospital procedure volume and death rates in pancreatic cancer patients in England. Design: Patients diagnosed with pancreatic cancer were identified from a linked cancer registration and Hospital Episode Statistics dataset. Cox regression analyses were used to assess all-cause mortality according to resection quintile and hospital volume, adjusting for sex, age, deprivation and comorbidity. Results: There were 31,973 pancreatic cancer patients studied, 2580 had surgery. Increasing resection rates were associated with lower mortality among all patients (chi(2)(1df) = 176.18, p(trend) < 0.001), with an unadjusted hazard ratio (HR) of 0.78 95%CI [0.75 to 0.81] in the highest versus the lowest resection quintile. Adjustment changed the estimate slightly (HR 0.82, 95%CI [0.79 to 0.85], (chi(2)(1df) = 99.44, P-trend < 0.001)). Among patients that underwent surgery, higher procedure volume was associated with lower mortality (HR = 0.88 95%CI [0.75-1.03] in hospitals carrying out 30+ versus

Primary liver cancer consists of distinct subtypes with differing aetiology so it is valuable to study the incidence of these subtypes separately. This study aims to investigate time and socio-economic deprivation trends in the incidence of primary liver cancer subtypes in England, identifying the burden in the population.Data were extracted from the population-based National Cancer Data Repository (NCDR) for patients diagnosed with primary liver cancer between 1990 and 2009. Subtypes were defined by the 10th edition of the International Classification of Diseases (ICD-10) codes: liver cell carcinoma (C22.0), intrahepatic bile duct carcinoma (C22.1), other (C22.2-C22.4, C22.7) and unspecified (C22.9). A sensitivity analysis was carried out on the main histological subtypes of liver cell carcinoma and intrahepatic bile duct using the 2nd edition of the International Classification of Diseases for Oncology (ICD-O-2). Male and female age-standardized incidence rates per 100 000 World standard population were calculated for each year and for the period 1999-2009 by socio-economic deprivation quintile.A total of 40 945 patients were diagnosed with primary liver cancer between 1990 and 2009. Liver cell carcinoma incidence increased in men from 0.63 in 1990 to 2.48 per 100 000 in 2009. While incidence was low in women, rates increased from 0.18 to 0.59, respectively. Intrahepatic bile duct carcinoma incidence increased between 1990 and 2009 from 0.40 to 1.25 per 100 000 in men, and from 0.28 to 1.08 in women. Incidence of the other liver cancer subtype remained low throughout the study period at less than 0.3 per 100 000 in each year in both men and women. The highest rate of liver cell carcinoma and intrahepatic bile duct carcinoma was generally in men and women resident in the most deprived areas between 1999 and 2009. The largest difference by deprivation quintile was observed for liver cell carcinoma in men, where the incidence was more than double in the most deprived quintile with an average rate of 3.56 per 100 000 compared to the least deprived quintile at 1.43.Liver cell carcinoma and intrahepatic bile duct carcinoma incidence increased between 1990 and 2009 in both sexes. This pattern was largely driven by patients living in the most deprived areas. Differences observed may be due to the variation in the prevalence of known risk factors such as chronic hepatitis B and C viral infections and excessive alcohol consumption.

We analysed data on 8987 larynx and 174060 lung cancer patients diagnosed between 1985 and 2004, of which 17.3% of larynx and 35.5% of lung cancers were in females. The age-standardised rates for each cancer declined in both sexes, but since the 1990s, the rates in females over 70 years of age have been diverging.

Triple negative breast cancer (TNBC) is associated with different ethnic groups in the United States (US), however this has not previously been examined in a population-based study within the United Kingdom (UK).Electronic pathology reports from the North East London Cancer Network (NELCN) on women diagnosed with breast cancer between 2005 and 2007 were collated. The statuses of oestrogen receptor, progesterone receptor and HER-2 were extracted. Women were classified as having TNBC if all three receptor statuses were negative, and as not having TNBC if at least one receptor was positive or borderline. Logistic regression was used to quantify the association between TNBC and ethnicity, adjusting for age, year of diagnosis and socioeconomic deprivation. Overall survival in different ethnic groups was examined using Cox regression, adjusting as appropriate for age, stage of disease, triple negative status, year of diagnosis, socioeconomic deprivation and recorded treatment.There were 2417 women resident in NELCN diagnosed with breast cancer between 2005 and 2007, and TNBC status was determined for 1228 (51%) women. Overall, of women who had their TNBC status determined, 128 (10%) were diagnosed with TNBC. Compared with White women, Black (odds ratio [OR]=2.81, p0.001) and South Asian (OR=1.80, p=0.044) women with breast cancer were more likely to have TNBC. Black women had a worse age-adjusted survival than White women (hazard ratio [HR]=2.05, p0.001). This was attenuated by further adjustment for stage of disease (1.52, p=0.032) and triple negative status (1.31, p=0.175).Better methods of early detection may need to be developed in addition to more effective systemic treatment in order to improve outcomes for women with TNBC.

Background: The patterns of primary liver cancer incidence and survival are not known for detailed ethnic groups within the UK. Methods: Data on patients resident in England diagnosed with primary liver cancer (ICD-10 C22) between 2001 and 2007 were extracted from the National Cancer Data Repository. Age-standardised incidence rate ratios (IRRs) were calculated for different ethnic groups separately for males and females, using the White ethnic groups as baselines. Overall survival was analysed using Cox regression, adjusting sequentially for age, socioeconomic deprivation and co-morbidity. Results: Ethnicity data were available for 75% (13,139/17,458) of primary liver cancer patients. Compared with the White male baseline, Chinese males had the highest IRR. Black African, Bangladeshi, Pakistani and Indian men also had statistically significant high IRRs. Black Caribbean men had a marginally elevated incidence rate compared with White men. In comparison with White women, Pakistani women had the highest IRR. Bangladeshi, Chinese, Black African and Indian women also had high IRRs. As observed in men, Black Caribbean women had an incidence rate closer to that of White women. Pakistani men and women, Black African women and Chinese men had statistically significantly better survival compared with their White counterparts. Conclusion: The variation found in the incidence of primary liver cancer, could be due to established risk factors such as hepatitis B and C infection being more prevalent among certain ethnic groups. Country of birth, age at migration and length of stay in England are likely to be important factors in this disease, and future research should examine these where possible.

Background Major changes in the incidence of oesophageal and gastric cancers have been reported internationally. This study describes recent trends in incidence and survival of subgroups of oesophageal and gastric cancer in England between 1998 and 2007 and considers the implications for cancer services and policy. Methods Data on 133,804 English patients diagnosed with oesophageal and gastric cancer between 1998 and 2007 were extracted from the National Cancer Data Repository. Using information on anatomical site and tumour morphology, data were divided into six groups; upper and middle oesophagus, lower oesophagus, oesophagus with an unspecified anatomical site, cardia, non-cardia stomach, and stomach with an unspecified anatomical site. Age-standardised incidence rates (per 100,000 European standard population) were calculated for each group by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan-Meier method. Results The majority of oesophageal cancers were in the lower third of the oesophagus (58%). Stomach with an unspecified anatomical site was the largest gastric cancer group (53%). The incidence of lower oesophageal cancer increased between 1998 and 2002 and remained stable thereafter. The incidence of cancer of the cardia, non-cardia stomach, and stomach with an unspecified anatomical site declined over the 10 year period. Both lower oesophageal and cardia cancers had a much higher incidence in males compared with females (M:F 4:1). The incidence was also higher in the most deprived quintiles for all six cancer groups. Survival was poor in all sub-groups with 1 year survival ranging from 14.8-40.8% and 5 year survival ranging from 3.7-15.6%. Conclusions An increased focus on prevention and early diagnosis, especially in deprived areas and in males, is required to improve outcomes for these cancers. Improved recording of tumour site, stage and morphology and the evaluation of focused early diagnosis programmes are also needed. The poor long-term survival reinforces the need for early detection and multidisciplinary care.

Background The incidence of small cell lung cancer (SCLC) is often quoted as ‘around 20%’ of all lung cancers but is reportedly decreasing over time. We analysed the trends in incidence of SCLC and compared these with the trends in lung cancer overall among males and females in South East England. Methods We identified 237,792 patients diagnosed with lung cancer (ICD-10 C33-C34) between 1970 and 2007. We used a Poisson regression age-cohort model to estimate the age-specific rates in the 1890–1960 birth cohorts. We computed age-standardised incidence rates using the European standard population. In addition, we analysed the trends of lung cancer subtypes according to morphology. Results In the most recent time period, SCLC accounted for 10% and 11% of cases of all lung cancer among males and females, respectively. Among the morphologically specified lung cancers, SCLC accounted for 15% and 17% among males and females, respectively. There was a decrease of SCLC incidence over time and by birth cohort in both sexes. The decrease in SCLC was more marked than that in all lung cancers. Conclusion The decrease in SCLC incidence rates may reflect decreases in the prevalence of cigarette smoking, and changes in the type of cigarettes smoked.

Background High volume upper gastrointestinal cancer hospitals demonstrate improved postoperative mortality rates, but the impact on survival is unclear. This population-based cohort study explores the effect of hospital volume on survival following upper gastrointestinal cancer surgery. Patients and methods This study used a population-based cohort of 3866 patients who underwent surgery for oesophageal or gastric cancer between 1998 and 2008 with follow-up until December 2008. Results Hospital volume ranged from 1 to 68 cases/year. Overall, 5-year survival was 27%. Increasing age and advanced stage of disease were independently correlated with shorter survival. High hospital volume was significantly and independently correlated with improved 30-day mortality postoperatively ( P Conclusion The correlation between hospital volume and improved 30-day mortality following oesophageal and gastric cancer surgery supports the centralisation of upper gastrointestinal cancer surgery services. The low survival in both high and low volume hospitals beyond 30 days highlights the need for increasing earlier diagnosis and optimising approaches to radical treatment.

There is growing evidence that the palliative care needs of certain people, such as those from minority ethnic groups, are not being met. The aim of this study was to investigate whether place of death from cancer differs between ethnic groups. A total of 101,516 patients resident in South East England and who died from lung, colorectal, breast or prostate cancer between 1998 and 2006 were extracted from the Thames Cancer Registry database. Ethnicity data were available for 68,804 patients (68%). The odds ratios (ORs) of death from cancer in a hospice, at home or in hospital were calculated. The results were adjusted for age at death, deprivation, cancer network of residence and time between diagnosis and death. Following adjustment, death in a hospice was significantly less likely for Pakistani patients (OR = 0.47 95% CI [0.30–0.74]), Indian patients (0.68 [0.55–0.84]) and Bangladeshi patients (0.33 [0.19–0.56]). Death at home was significantly less likely in Black African patients (0.48 [0.36–0.65]), Black Caribbean patients (0.78 [0.67–0.90]) and Chinese patients (0.46 [0.28–0.76]). Pakistani, Indian, Bangladeshi, Black African, Black Caribbean and Chinese patients were all significantly more likely than White patients to die in hospital. The results were not substantially altered by recoding the unknown ethnicity group to White or using multiple imputation to assign those with a missing ethnicity an ethnic group. Place of death varies between ethnic groups. This may reflect differences in preferences for place of death or barriers to accessing specialist care in different settings. More detailed prospective qualitative studies are urgently required to determine reasons for this variation.

Women living in socioeconomically deprived areas have a lower incidence of breast cancer (Shack et al, 2008), but a lower survival than those in affluent areas (Coleman et al, 2004). Variation in survival between English health authority areas is partly explained by their differing levels of deprivation (Mullee et al, 2004). Women from Black Caribbean and Black African ethnic groups have a lower incidence of breast cancer, but a lower survival than White women (Jack et al, 2009). These inequalities deserve investigation to identify factors amenable to intervention. For example, lower survival in one Swedish health district appeared to be because of a lower intensity of diagnostic tests influencing accurate staging and the treatment women received (Eaker et al, 2005). Investigations within English regions found that women living in deprived areas presented more often with advanced disease (Adams et al, 2004; Downing et al, 2007; Cuthbertson et al, 2009; Wishart et al, 2010). The lower survival of women from Black ethnic groups in South East England was largely explained by more advanced disease and socioeconomic deprivation (Jack et al, 2009). This study investigates low breast cancer survival in North East London Cancer Network (NELCN). For the period 2001–2005, the 5-year relative survival was 75% (95% confidence interval (CI): 73.5–76.9) vs 79% (CI: 78.3–79.7) for London as a whole (Thames Cancer Registry, 2007b). North East London Cancer Network was also a low outlier for 1-year relative survival in England (National Cancer Intelligence Network, 2008). Our objectives were (1) to investigate whether differences in demographic, clinical or treatment characteristics between NELCN women and the rest of London explained this survival difference and (2) to identify clinical or public health approaches to improve survival.

The future burden of cancer in England is predicted to increase by 33% by 2020. Those planning health services are often interested in predictions at a local level. This study aimed to estimate the future burden of cancer in London and compare this with estimates for England.Predictions for London were based on cancer registration data (1985-2003) and population projections up until 2024. The number of future cases and age-standardized incidence rates (ASRs) were projected using an age-period-cohort model developed for the analysis of cancer trends and projections in the Nordic countries. Estimates for England were taken from an earlier publication.In London, ASRs for all cancers (excluding non-melanoma skin cancer) decreased for both sexes, whereas in England, ASRs decreased in males and increased slightly in females. In London, the number of cases for both sexes is predicted to increase from approximately 27,000 in 2002 to approximately 28,500 in 2022, an increase of 5%. In England, a greater increase is predicted, from approximately 224,000 in 2001 to approximately 299,000 in 2020, an increase of 33%.Projections of the future burden of cancer are particularly sensitive to demographic population trends. They are likely to be different for cities compared with rural areas or entire countries.

98 Background: In Europe, several countries have implemented national audit programs to reduce variation in outcomes and improve care for esophageal and gastric cancer. These audits provide insight in national variations, but currently no international comparisons can be made. Purposes of the current study were to compare patterns of care and outcomes in several European countries, and to evaluate the effect of hospital volume on outcomes for esophagectomy and gastrectomy. Methods: Data were obtained from national cancer registries or audits in the Netherlands, Sweden, Denmark, and the United Kingdom. Differences in postoperative 30-day mortality and 2-year survival were adjusted for available case-mix variables and separately analyzed for esophagectomy and gastrectomy, using generalized estimated equations and Cox regression. In the current study, high-volume hospitals were defined as hospitals with an annual volume of > 20. Results: From 2004-2009, 10,854 esophagectomies and 9,010 gastrectomies were performed in the participating countries. Availability of case-mix variables varied between countries, and a limited number of variables could be used in the international comparison. On univariate analysis, 30-day mortality and 2 year survival differed significantly between participating countries, but on multivariate analysis, no significant differences were found. The percentage of resections performed in high-volume hospitals varied considerably between countries (esophagectomy: 20% to 94%, gastrectomy: 0% to 59%). Increasing annual hospital volume was associated with lower 30-day mortality after esophagectomy (P < 0.001) and gastrectomy (P = 0.025), and with improved 2-year survival after esophagectomy (P = 0.004), but not after gastrectomy. Conclusions: This study provides an initial step towards a European Upper GI Cancer Audit. However, with the available data only limited case-mix adjustments could be made. Future steps would include synchronization of registered variables and the use of uniform variable definitions. Increasing annual hospital volume is associated with improved short-term outcomes of upper GI cancer surgery.

BackgroundData from providers of private cancer care are not yet formally included in English cancer registration data. This study aimed to test the exchange of breast cancer data from one Hospital Corporation of America International (HCAI) hospital in London with the cancer registration system and assess the suitability of these data for comparative analyses of case mix and adjusted survival.MethodsData on 199 London women receiving ‘only HCAI care’, 278 women receiving ‘some HCAI care’ (HCAI and other services), and 31,234 other London women diagnosed between 2005 and 2011 could be identified and compared. Overall survival was estimated using the Kaplan-Meier method, and Cox regression was used to adjust for age, socioeconomic deprivation, year of diagnosis, stage of disease and recorded treatment.ResultsWomen receiving ‘only HCAI care’ were younger, lived in areas of higher affluence (47.8 % vs 27.6 %) and appeared less likely to be recorded as having screen-detected (2.5 % vs 25.0 %) disease than other London women. Women receiving ‘some HCAI care’ were more similar to ‘HCAI only’ women. Although HCAI stage of disease data completeness improved during the study period, this was less complete overall than cancer registration data and limited the comparative survival analyses. An apparent survival advantage for ‘HCAI only’ women compared with other London women (hazard ratio 0.48, 95 % confidence interval (CI): 0.32-0.74) was attenuated and no longer statistically significant after adjustment (0.79, 95 % CI: 0.51-1.21). Women receiving ‘some HCAI care’ appeared to have higher survival (hazard ratio 0.24, 95 % CI 0.14-0.41) which was attenuated to 0.48 (95 % CI: 0.28-0.80) in the fully adjusted model.ConclusionsExchange of data between the private cancer sector and the English cancer registration service can identify patients who receive all or some private care. The better survival of women receiving only or some HCAI breast cancer care appears to be at least partly explained by demographic, disease, and treatment factors. However, larger studies using similarly quality assured datasets and more complete staging data from the private sector are needed to produce definitive comparative results.