title: Rate of positive diagnosis of skin cancer and its stage in two-week wait referrals in England according to age.
abstract: BACKGROUND
  The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer.
  
  
  OBJECTIVE
  To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC).
  
  
  METHODS
  We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age.
  
  
  RESULTS
  TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence.
  
  
  CONCLUSIONS
  Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Keith
authors.affiliation: Public Health England-South West, Bristol, UK.
authors.forename: T
authors.initials: T
authors.lastname: Jones
authors.affiliation: Public Health England-South West, Bristol, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ives
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: de Berker
authors.affiliation: Public Health England-South West, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Verne
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D055088:Early Detection of Cancer; D004739:England / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult