Urgent suspected cancer referrals

This interactive dashboard provides referral, conversion, and detection rates for urgent suspected cancer referrals. The rates are provided, by financial year, for a range of referral or cancer sites, NHS geographies, and demographic breakdowns (gender, age, deprivation, and ethnicity).

The dashboard is designed for users interested in understanding the frequency of urgent suspected cancer referrals, variation in the use of these referrals and their contribution to diagnostic pathways. The data provides information to help understand access to health care and health service workload, and to inform resource or intervention planning for cancer diagnostic pathways.

Acknowledgement

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.

Urgent suspected cancer (USC) referrals are used for people with possible cancer symptoms, to refer them to secondary care for investigation and possible diagnosis. USC referrals are commonly known as two-week wait referrals due to a previous Cancer Waiting Times (CWT) target that, within two weeks of being referred from their GP, individuals should be seen by a specialist in secondary care.

The metrics included in the dashboard are:

1. Referral rate: The number of USC referrals multiplied by 100,000 divided by the population.
2. Conversion rate: The percentage of USC referrals which result in a diagnosis of cancer.
3. Detection rate: The percentage of cases recorded in the CWT as receiving a first treatment for cancer which resulted from a USC referral.

These rates are not adjusted by age, gender or other factors which may affect differences in the rates between geographies and cancer sites.

Cohorts

Data for England is reported by financial year, running from 1st April to 31st March, from April 2009 onwards. The years included in the dashboard are based on:

1. Referral and conversion rates: The date first seen in secondary care for urgent suspected cancer referrals.
2. Detection rates: The treatment start date for patients receiving a first treatment for cancer.

Datasets

The Cancer Waiting Times (CWT) dataset is used to support the management and monitoring of cancer services in England, recording details of all urgent suspected cancer referrals and all patients receiving a first treatment for cancer.

Population denominators are published by the Office for National Statistics (ONS) for small areas by age and gender, and by broad ethnic group.

Ethnicity groupings are derived from linkage to Hospital Episode Statistics data.

Referral types for referral and conversion rates

Referral rate and conversion rate data are available for 15 broad referral types based on the CWT urgent suspected cancer referral or symptomatic breast referral types:

[1] For the April 2019 to March 2020 financial year, any referrals for the non-specific symptoms referral type were aggregated into the 'other' referral type category data. From April 2020 to March 2021 financial year, the referral type for non-specific symptoms has been reported separately.

[2] From April 2020 to March 2021 financial year, a new 'other suspected cancer' referral type was introduced; data has been aggregated for both 'other' referral type categories.

Cancer sites for detection rates

Detection rate data is available for 12 broad cancer sites which relate to the urgent suspected cancer referral types. These site groups are based on the primary diagnosis code recorded in the CWT data for the first treatment record, which is classified using the 10th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a medical classification list produced by the World Health Organisation (WHO). ICD-10 codes have been grouped into sites related to the urgent suspected cancer referral types, as follows:

Geographies

The tool presents the referral rate, conversion rate and detection rate data for urgent suspected cancer referrals for a range of geographies: England; NHS regions; Cancer Alliances; Integrated Care Boards (ICBs); and sub-Integrated Care Boards (sub-ICBs).

All geographies refer to the areas they cover, as at April 2024, based on the patients' postcodes of residence.

All cancer data compared to site-specific data

1. All cancer data: Referral rates, conversion rates and detection rates are based on any referral type (except breast symptom referrals) and any cancer site, including diagnoses of a cancer type different to the suspected cancer referral type (for example, including diagnoses of lower GI cancer following an urgent referral for suspected upper GI cancer).
2. Site-specific data: Conversion rates and detection rates are based on referrals and diagnoses of the same referral type and cancer site (for example, the urological cancer detection rate is the percentage of urological cancers which resulted from an urgent referral for suspected urological cancers). Exceptions to this are:
   • conversion rates for suspected children's cancer, suspected sarcoma and other suspected cancer which include all diagnoses;
   • cancer diagnoses for children which are included in detection rates for all individual cancer sites rather than as a separate detection rate, and
   • detection rates for sarcoma and other cancers which include urgent referrals for any suspected cancer.

Unavailable data

As detection rate is based on the ICD-10 diagnosis code, the data is not available separately for:

• children: Instead, all diagnoses for children (including those which resulted from an urgent suspected children's cancer referral) are included under the relevant cancer sites of diagnosis.
• breast symptoms: Instead, breast cancer diagnoses which resulted from a breast symptoms referral are included within the breast cancer detection rate.

Data is not available for some less common referral types or cancer sites and smaller geography combinations, or for some demographic breakdowns, because the referral, conversion or detection rates would be based on a relatively small number of cases. This means they would be subject to significant variation due to random chance, which would hinder the meaningful interpretation of rates. Where possible, data is instead provided for rolling 3-year aggregated periods or only for more recent years. However, there remain some cases where it was not possible to provide a meaningful alternative.

Impact of COVID-19

There have been changes in trends due to COVID-19 impacting on some activity. Please consider this at all times when interpreting data for April 2020 to March 2021 particularly and, to a smaller degree, data for April 2019 to March 2020.

Methodology notes

Where age, gender or LSOA information was missing in the CWT data, these records have been excluded from the analysis.

Records were excluded for:

• suspected children's cancer referrals for patients aged 20 and over;
• suspected gynaecological cancer referrals or gynaecological cancers for men; and
• suspected testicular cancer referrals or cancers of male genital organs (for example, prostate or testes) for women.

For referral rates by ethnic group, population estimates by ethnic group were not available for 2009, 2010, 2020, 2021, 2022 at the time of publication. Instead, population estimates for 2011 have been used for 2009 and 2010 and population estimates for 2019 have been used for 2020, 2021 and 2022.

For referral rates, different population denominators have been used for some referral types:

• the suspected children's cancer referral rate is based on the population aged 0 to 19.
• the suspected gynaecological cancer referral rate is based on the female population aged 15 and over.
• the all suspected cancers referral rate is based on the total population, for males and females and all ages.

All other referral rates are based on the male and female population aged 15 and over (except rates by gender or age, as appropriate).

For all the rates, 95% confidence intervals are provided. To calculate confidence intervals, the Byar's method was used for referral rates and the Wilson's Score method was used for conversion and detection rates.

Ethnicity has been derived from the UK Health Security Agency's DataLake at a patient level, which compiles hospital data, specifically Hospital Episode Statistics (HES) and Secondary Uses Service (SUS) data.

Breakdowns

Age: Rates are available for 5-year and 10-year age-groups. For 10-year age-groups, rates are calculated after data is grouped, with an under 50 group and 80+ group. For 5-year age groups, data is provided for age-groups ranging from 0-to-4 years to 90+ years, where possible, although sometimes the data has been grouped for younger and older age groups

Deprivation: Rates are calculated after data is grouped into IMD deprivation quintiles, with '1' representing the most deprived quintile and '5' representing the least deprived quintile

Ethnicity: Rates are calculated for ethnicity data, which is grouped into broad Asian, Black, White, Mixed and Other, and Unknown ethnicity groupings as follows:

Other data sources

Cancer Services: All cancer conversion rates and detection rates are available for GP practices, primary care networks, sub-ICB and ICB, based on registered GP practice.

Cancer Waiting Times statistics: Levels of activity and performance for cancer waiting times are available for providers and commissioners.

The tool is produced by the National Disease Registration Service (NDRS). Please send any feedback or queries to [email protected] 

Please do not include sensitive or patient identifiable information.

To access the data used in the dashboard, please choose either ‘(2) Geographical variation’, ‘(3) Cancer site variation’ or ‘(4) Demographic breakdown’, select your filters of interest on the left panel, and scroll to the bottom of the left panel to download data.

You can also download the descriptive summaries comparing crude referral rates, conversion rates and detection rates for each cancer site. These are available by geography or by demographic breakdown, by selecting from the boxes below: