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Routes To Diagnosis

Since the publication of the Cancer Reform Strategy in 2007 and continuing with Improving outcomes: a strategy for cancer, cancer survival has been a key area for improvement in England. Compared to the European average cancer survival in England is low. Studies suggested this difference could be largely due to later diagnosis, when cancers have progressed to a more advanced stage and are harder to treat. In 2012 a study was published attempting to shed more light on patients journeys to diagnosis to see what could be improved.

This was the award-winning Routes to Diagnosis study, which defined a methodology to determine the route a patient took through the healthcare system before receiving a cancer diagnosis. Routes to diagnosis found large differences in how patients were diagnosed and large variation in survival between these groups. In particular it was found that one in four cancer patients were diagnosed as an emergency presentation, and that this route was associated with low survival.

Results include patients diagnosed in the eleven year time period from 2006 to 2016. A case study was published in 2016 for the Quality in Care Programme.


Administrative Hospital Episode Statistics (HES) data are combined with Cancer Waiting Times (CWT) data, data from the cancer screening programmes and cancer registration data from the National Cancer Data Repository (NCDR). Using these datasets every case of cancer registered in England which was diagnosed in 2006-2016 is categorised into one of eight 'Routes to Diagnosis'.

The methodology is described in detail in the British Journal of Cancer article, published in October 2012 Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets.

Outputs available for the 2006-2016 iteration include:

Routes to Diagnosis 2006 2016 workbook published version a.xlsx: This spreadsheet presents the key incidence and survival statistics from the Routes to Diagnosis work. Two types of data are presented; the percentage of total cancers that are diagnosed by each Route, and the net survival for each Route. The user can select the cancer type of interest, the year of diagnosis or the survival period. Data are presented by sex, age group and deprivation quintile as well as by ethnicity for incidence.

Routes to Diagnosis 2006 2016 workbook published version 2.1b.xlsx: This spreadsheet presents incidence metrics further broken down from the Routes to Diagnosis work. Three sets of data are presented; more detail for the percentage of cancers diagnosed by emergency Routes, results by Cancer Alliance and results for four cancer sites by Clinical Commissioning Group (CCG). A stage breakdown is also included.

Routes to Diagnosis 2006 2015 technical document.pdf: Technical document: This document summarises the data sources and methodology used for this Routes to Diagnosis project.

Different cancer types show substantial differences between the proportions of cases that present by each Route. Patients presenting via Emergency Routes have substantially lower one-year net survival. Cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to explore possible reasons for delayed diagnosis, direct the focus of early diagnosis initiatives and identify areas for further research. Further information is available here.

For more detailed statistics on routes to diagnosis, please go here.