Referral rates, conversion rates and detection rates for urgent suspected cancer referrals have been published for a range of geographies within England, for all cancers and by referral type or cancer site. These results provide insights, for all cancer groups, into referral activities and their contribution to diagnostic pathways. They should improve the understanding of cancer diagnostic pathways and inform resource or intervention planning.
For each cancer site, this document provides a descriptive summary comparing referral rates, conversion rates and detection rates, including:
There have been changes in trends due to the impact of COVID-19 on some activity. Please consider this at all times when interpreting data for April 2020 to March 2021 figures in particular and, to a smaller degree, April 2019 to March 2020 figures.
For sarcoma, brain or central nervous system (CNS) cancers, childhood cancers, and other cancers at smaller geographical levels, conversion and detection rates are not presented in the descriptive summary due to small number of cases. For lower gastrointestinal (GI), upper GI, gynaecological, haematological and head and neck sites, some combinations of geography and site are based on 3-year rolling averages, in these cases the conversion and detection rates are not presented in the descriptive summary.
From April 2020 to March 2021, additional referral types are aggregated into the Other referral type category. These include a referral type for non-specific symptoms and a new Other suspected cancer referral type.
Differences in referral rates, conversion rates and detection rates by site (of referral or diagnosed tumour) may reflect different symptom profiles, diagnostic complexity and pathways.
Using Cancer Waiting Times (CWT) data, provided by NHS England, urgent suspected cancer referrals, conversion rate and detection rate are defined as follows:
The majority of patients urgently referred for suspected cancer are not diagnosed with cancer, meaning that the number of urgent referrals for suspected cancer exceeds the number of cases recorded in the CWT data as receiving a first treatment for cancer. Therefore, conversion rates, based on the number of urgent referrals for suspected cancers, usually relate to a much larger number of patients than detection rates, which are based on the number of cases recorded in the CWT data as receiving a first treatment for cancer. Consequently, the range and variation in conversion rates tends to be smaller than for detection rate, as there is less variation due to random chance when higher numbers of events are observed. Similarly, ranges in the rates tend to be smaller for NHS regions than for Cancer Alliances (CAs), and in turn for Integrated Care Boards (ICBs) and Sub-Integrated Care Boards (sub-ICBs).
This work uses data that has been provided by patients and collected by the NHS as part of their care and support. It is sourced from NHS England and collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS England.
For England, the crude urgent referral rate for all suspected cancers has increased from 1,730 per 100,000 for the year ending March 2010 to 5,071 per 100,000 for the year ending March 2023 (Figure 1). The conversion rate of urgent referrals for all suspected cancers has decreased over time, from 10.8% for the year ending March 2010 to 6.0% for the year ending March 2023 (Figure 2). Over the same period, the detection rate for all cancers has increased from 42.3% to 55.6%.
Crude referral rates, conversion rates and detection rates vary by NHS Region, CA, ICB and sub-ICB (Figure 3), and have changed over time, from the year ending March 2010 to the year ending March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 3,494 per 100,000 to 7,268 per 100,000, conversion rates for sub-ICBs range from 3.1% to 9.1% and detection rates for sub-ICBs range from 44.4% to 64.1%.
For England, the crude urgent suspected brain or CNS cancer referral rate has increased from 10 per 100,000 for the year ending March 2010 to 25 per 100,000 for the year ending March 2023 (Figure 4). The conversion rate of urgent brain or CNS cancer referrals has decreased over time, from 1.9% for the year ending March 2010 to 0.7% for the year ending March 2023 (Figure 5). Over the same period, the detection rate for brain or CNS tumours remained similar, changing from 3.2% to 2.8%.
For England, the crude urgent suspected breast cancer referral rate has increased from 432 per 100,000 for the year ending March 2010 to 1,027 per 100,000 for the year ending March 2023 (Figure 6). The conversion rate of urgent breast cancer referrals has decreased over time, from 10.5% for the year ending March 2010 to 5.3% for the year ending March 2023. Over the same period, the detection rate for breast cancers has decreased from 56.9% to 54.0% (Figure 7).
Crude referral rates, conversion rates and detection rates vary by NHS Region, CA, ICB and sub-ICBs (Figure 8), and have changed over time, from the year ending March 2010 to the year ending March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 697 per 100,000 to 1,573 per 100,000, conversion rates for sub-ICBs range from 3.0% to 9.7% and detection rates for sub-ICBs range from 30.7% to 75.3%.
For England, the crude urgent breast symptoms referral rate has changed from 391 per 100,000 for the year ending March 2010 to 267 per 100,000 for the year ending March 2023 (Figure 9). The conversion rate of urgent referrals for breast symptoms has decreased over time, from 1.2% for the year ending March 2010 to 1.2% for the year ending March 2023 (Figure 10).
Crude referral rates and conversion rates vary by NHS Region, CA, ICB and sub-ICB (Figure 11), and have changed over time, from the year ending March 2010 to March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 8 per 100,000 to 691 per 100,000 and conversion rates for sub-ICBs range from 0.0% to 9.0%.
For England, the crude urgent suspected children’s cancer referral rate has increased from 45 per 100,000 for the year ending March 2010 to 110 per 100,000 for the year ending March 2023 (Figure 12). The conversion rate of urgent suspected children’s cancer referrals has decreased over time, from 1.0% for the year ending March 2010 to 0.4% for the year ending March 2023 (Figure 13).
For England, the crude urgent suspected gynaecological cancer referral rate has increased from 383 per 100,000 for the year ending March 2010 to 1,168 per 100,000 for the year ending March 2023 (Figure 14). The conversion rate of urgent gynaecological cancer referrals has decreased over time, from 6.6% for the year ending March 2010 to 2.9% for the year ending March 2023. Over the same period, the detection rate for gynaecological cancers has increased from 42.8% to 58.3% (Figure 15).
For England, the crude urgent suspected haematological cancer referral rate has increased from 18 per 100,000 for the year ending March 2010 to 18 per 100,000 for the year ending March 2023 (Figure 16). The conversion rate of urgent suspected haematological cancer referrals has decreased over time, from 31.5% for the year ending March 2010 to 20.3% for the year ending March 2023. Over the same period, the detection rate for haematological cancers has increased from 14.9% to 23.0% (Figure 17).
For England, the crude urgent suspected head and neck cancer referral rate has increased from 170 per 100,000 for the year ending March 2010 to 583 per 100,000 for the year ending March 2023 (Figure 18). The conversion rate of urgent suspected head and neck cancer referrals has decreased over time, from 4.2% for the year ending March 2010 to 2.6% for the year ending March 2023. Over the same period, the detection rate for head and neck cancers has increased from 37.0% to 58.6% (Figure 19).
For England, the crude urgent suspected lower GI cancer referral rate has increased from 327 per 100,000 for the year ending March 2010 to 1,197 per 100,000 for the year ending March 2023 (Figure 20). The conversion rate of urgent suspected lower GI cancer referrals has decreased over time, from 6.4% for the year ending March 2010 to 2.8% for the year ending March 2023. Over the same period, the detection rate for lower GI cancers has increased from 33.2% to 50.2% (Figure 21).
For England, the crude urgent suspected respiratory system (lung) cancer referral rate has increased from 85 per 100,000 for the year ending March 2010 to 145 per 100,000 for the year ending March 2023 (Figure 22). The conversion rate of urgent suspected respiratory system (lung) cancer referrals has decreased over time, from 26.4% for the year ending March 2010 to 12.7% for the year ending March 2023. Over the same period, the detection rate for respiratory system (lung) cancers has decreased from 36.4% to 28.0% (Figure 23).
Crude referral rates, conversion rates and detection rates vary by NHS Region, CA, ICB and sub-ICB (Figure 24), and have changed over time, from the year ending March 2010 to the year ending March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 54 per 100,000 to 320 per 100,000, conversion rates for sub-ICBs range from 3.2% to 42.7% and detection rates for sub-ICBs range from 4.8% to 46.4%.
For England, the crude urgent suspected sarcoma referral rate increased from 8 per 100,000 for the year ending March 2010 to 33 per 100,000 for the year ending March 2023 (Figure 25). The conversion rate of urgent suspected sarcoma referrals has decreased over time, from 11.3% for the year ending March to 4.9% for the year ending March 2023. Over the same period, the detection rate for sarcoma has increased from 25.9% to 46.7% (Figure 26).
For England, the crude urgent suspected skin cancer referral rate has increased from 371 per 100,000 for the year ending March 2010 to 1,345 per 100,000 for the year ending March 2023 (Figure 27). The conversion rate of urgent suspected skin cancer referrals has decreased over time, from 8.3% for the year ending March 2010 to 6.2% for the year ending March 2023. Over the same period, the detection rate for skin cancers has increased from 46.9% to 67.4% (Figure 28).
Crude referral rates, conversion rates and detection rates vary by NHS Region, CA, ICB and sub-ICB (Figure 29), and have changed over time, from the year ending March 2010 to the year ending March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 434 per 100,000 to 2,506 per 100,000, conversion rates for sub-ICBs range from 2.4% to 11.9% and detection rates for sub-ICBs range from 40.0% to 84.0%.
For England, the crude urgent suspected urological cancer referral rate has increased from 248 per 100,000 for the year ending March 2010 to 579 per 100,000 for the year ending March 2023 (Figure 30). The conversion rate of urgent suspected urological cancer referrals has decreased over time, from 20.3% for the year ending March 2010 to 15.9% for the year ending March 2023. Over the same period, the detection rate for urological cancers has increased from 47.2% to 69.4% (Figure 31).
Crude referral rates, conversion rates and detection rates vary by NHS Region, CA, ICB and sub-ICB (Figure 32), and have changed over time, from the year ending March 2010 to the year ending March 2023. For the year ending March 2023, crude referral rates for sub-ICBs range from 336 per 100,000 to 796 per 100,000, conversion rates for sub-ICBs range from 9.0% to 24.5% and detection rates for sub-ICBs range from 49.4% to 84.1%.
For England, the crude urgent suspected upper GI cancer referral rate has increased from 217 per 100,000 for the year ending March 2010 to 471 per 100,000 for the year ending March 2023 (Figure 33). The conversion rate of urgent suspected upper GI cancer referrals has decreased over time, from 6.2% for the year ending March 2010 to 3.7% for the year ending March 2023. Over the same period, the detection rate for upper GI cancers has increased from 33.0% to 38.4% (Figure 34).
For England, the crude urgent non-specific symptoms referral rate has changed from 4 per 100,000 for the year ending March 2021 to 43 per 100,000 for the year ending March 2023 (Figure 35). The conversion rate of urgent referrals for non-specific symptoms has decreased over time, from 2.6% for the year ending March 2021 to 2.6% for the year ending March 2023 (Figure 36).
For England, the crude urgent referral rate for other suspected cancers has decreased from 10 per 100,000 for the year ending March 2010 to 12 per 100,000 for the year ending March 2023 (Figure 37). The conversion rate of urgent referrals for other suspected cancers has decreased over time, from 15.3% for the year ending March 2010 to 5.7% for the year ending March 2023. Over the same period, the detection rate for other cancers has increased from 35.8% to 38.5% (Figure 38).
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