Case-mix adjusted percentage of cancers diagnosed at stages 1 and 2 by sub-ICB in England, 2021

In 2020, there was a decrease in the number of cancers diagnosed with a valid stage in England, which fell 7.5% from 236,761 cancers in 2019 to 219,047 cancers in 2020. This lower number of cancers with a valid stage reflects the reported 12% fall in the total number of cancers registered for 2020. This contrasted with the normal pattern of small year-on-year increases in diagnoses that was seen up to 2019. For this reason, we compare the number of cancers diagnosed with a valid stage in 2021 against 2019 in the rest of this publication as a more stable comparison.

In England, there were 244,208 cancers diagnosed with a valid stage in 2021, which was 79% of all stageable cancers. This is in line with 236,761 cancers diagnosed in 2019. Of all cancers diagnosed in 2021 with a valid stage, 54% were diagnosed at stages 1 and 2. This is the same proportion as in 2019, 54%. The range over the period 2013 to 2018 was 54% to 55%.

Comparisons between geographies using unadjusted values of the indicator may be misleading because of differences between the underlying population characteristics and distribution of risk factors. Populations within sub-ICBs consist of a differing mix of people in terms of their characteristics such as age, gender and deprivation.

Case-mix adjustment is a process which accounts for differences in these population characteristics when calculating outcomes (e.g. percentage of cancers diagnosed at early stage). This allows for fairer comparisons of outcomes between sub-ICBs that have populations with different characteristics negatively or positively associated with the performance indicator.

Up to diagnoses made in 2019, a total of 21 cancer sites/groups could be included in the ‘case-mix adjusted percentage of cancers diagnosed at stages 1 and 2’ indicator. From 2020, this number reduces to 18 cancer sites/groups because there were lower levels of staging in cervix, stomach and thyroid cancers that means these cancer sites/groups currently fail the inclusion criteria.

There are 18 cancer sites/groups included in the ‘case-mix adjusted percentage of cancers diagnosed at stages 1 and 2’ indicator, with 220,099 cancers diagnosed with a valid stage in 2021 in England. This is in line with the 214,036 cancers in 2019 after adjusting for removing cervix, stomach and thyroid cancer sites/groups previously included.

The overall case-mix adjusted percentage of cancers diagnosed at stages 1 and 2 was 54% for the most recent 3-year period (2019 to 2021). This is the same (54%) as for the previous 3-year period (2018 to 2020) but lower than all other 3-year periods since 2013 to 2015, when it remained stable at 55%.

During 2019 to 2021, the range of case-mix adjusted percentage of cancers diagnosed at stages 1 and 2 across the 106 sub-ICBs was 50% to 58% which is smaller than the unadjusted range (48% to 59%). This shows that some of the variation in the percentage of cancers diagnosed at stages 1 and 2 between sub-ICBs is associated with the population characteristics.

When assessing trends in sub-ICBs over individual years, the focus should be on overall trends rather than year-on-year variation. This is because the number of cases diagnosed each year in each sub-ICB is relatively small and the estimates are therefore less stable. There are no obvious geographical patterns to the sub-ICB variation. ]