Stage at diagnosis and early mortality from cancer in England.
BACKGROUND
Stage at diagnosis is a key predictor of overall cancer outcome. For the first time, stage completeness is high enough for robust analysis for the whole of England.


METHODS
We analysed data from the National Cancer Registration Service's (NCRS) Cancer Analysis System on persons diagnosed with breast, colorectal, lung, prostate or ovarian cancers in England in 2012. One-year relative survival (followed-up to the end of 2013) was calculated along with adjusted excess rate ratios, for mortality within 1 year.


RESULTS
One-year relative survival decreased with increasing stage at diagnosis. For breast, prostate and colorectal cancers survival showed a major reduction for stage 4 cancers, whereas for lung and ovarian cancers there were substantial decreases in relative survival for each level of increase in stage. Excess rate ratios for mortality within 1 year of diagnosis showed that stage and age were the most important cofactors, but they also identified the statistically significant effects of sex, income deprivation and geographic area of residence.


CONCLUSIONS
Further reductions in mortality may be most effectively achieved by diagnosing all cancers before they progress to stage 4, but for lung and ovarian cancers there is also a need for a stage shift to earlier stages together with efforts to improve stage-specific survival at all stages.
National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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McPhail
National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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Johnson
National Cancer Registration Service (NCRS), Public Health England, Unit C, Magog Court, Shelford Bottom, Hinton Way, Cambridge CB22 3AD, UK.
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Greenberg
National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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Peake
National Cancer Registration Service (NCRS), Public Health England, Unit C, Magog Court, Shelford Bottom, Hinton Way, Cambridge CB22 3AD, UK.
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Rous
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D055088:Early Detection of Cancer; D004739:England; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000401:mortality; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D012042:Registries; D015996:Survival Rate; D055815:Young Adult