• 33.5% where the patient had a GP red-flag referral (suspected cancer referral) 

• 23.3% where the patient presented as an emergency inpatient to hospital 

• 19.7% where the patient had a GP referral to outpatients that was not a red-flag referral 

• 11.8% where the patient had an outpatient appointment which was not a direct result of a GP referral  

• 5.8% where the patient was referred from a cancer screening programme 

• 2.2% where the patient had an elective inpatient appointment with no earlier admission recorded 

• 0.4% where no data was available on the patient, except for reference to cancer on a death certificate 

• 3.4% where no data was available on the patient  

Screening 

• The screening route to diagnosis only applies to certain cancers and age groups. For these groups: 52.5% of female breast cancer patients aged 50 to 70; 43.6% of cervical cancer patients aged 25 to 64 and 22.4% of colorectal cancer patients aged 60 to 74 were diagnosed via the screening route.

Red-flag referrals 

• Diagnosis following a red-flag (suspected cancer) referral ranged from 60.7% for uterine cancer patients and 58.3% for malignant melanoma patients to 7.5% for gallbladder and biliary cancer patients and 1.7% for brain and central nervous system cancer patients. 

• For the four most common cancer types: 46.9% of female breast cancer patients; 48.7% of prostate cancer patients; 33.5% of colorectal cancer patients and 20.9% of lung cancer patients were diagnosed via the red-flag referral route.

Emergency admissions 

• Diagnosis following an emergency admission ranged from 61.7% for brain and central nervous system cancer patients and 60.6% for gallbladder and biliary cancer patients to 3.7% for female breast cancer patients and 1.5% for malignant melanoma patients. 

• For the four most common cancer types: 41.5% of lung cancer patients; 28.0% of colorectal cancer patients; 8.2% of prostate cancer patients and 3.7% of female breast cancer patients were diagnosed via the emergency presentation route.

Age at diagnosis 

• Route to diagnosis was associated with patients age at diagnosis with the proportion of cancer cases (excluding non-melanoma skin cancer) diagnosed via a red-flag referral 36.2% among patients aged 0 to 64 compared to 30.2% among patients aged 75 and over.  

• The proportions diagnosed via an emergency presentation were 17.3% and 31.6% for patients aged 0 to 64 and 75 and over respectively, while a screening referral was the route taken by 9.2% of patients aged 0 to 64 and 0.6% of patients aged 75 and over.  

Stage at diagnosis 

• There was a strong relationship between route to diagnosis and stage at diagnosis with the proportion of cancer (ex NMSC) cases diagnosed via a red-flag referral being 36.7% among stage I cancers compared to 27.1% among stage IV cancers.  

• The proportions diagnosed via a screening referral were 12.4% and 0.5% for stage I and stage IV cancers respectively, while an emergency presentation was the route taken in 6.6% of cases diagnosed at stage I and 43.3% of cases diagnosed at stage IV. 

• The large variation in route to diagnosis by stage was apparent for most cancer types. 

• 31.4% of stage IV female breast cancers were diagnosed via an emergency admission route compared to 1.6% of stage I cancers 

• 56.7% of stage IV lung cancers were diagnosed via an emergency admission route compared to 19.9% of stage I cancers 

• 48.9% of stage IV colorectal cancers were diagnosed via an emergency admission route compared to 5.5% of stage I cancers 

Deprivation and urban/rural status 

• The emergency admission route to diagnosis was more common in the most deprived areas (26.2%) than the least deprived areas (21.1%) of NI and was more common in urban (24.7%) than rural areas (21.1%).  

• There was variation in patients’ route to diagnosis by area-based deprivation for female breast cancer, prostate cancer and melanoma with the red-flag referral route more common in deprived areas, and upper gastrointestinal cancer (stomach and oesophagus) with the emergency admission route more common in deprived areas. 

• There was variation in patients’ route to diagnosis by urban/rural status for gynaecological and upper gastrointestinal cancer with the red-flag referral route more common in rural areas, and melanoma with the red-flag referral route more common in urban areas.

Trends over time 

• The proportion of cases diagnosed via a screening referral route increased from 4.8% in 2020 to 6.7% in 2021, while presentation via a red-flag referral route increased from 33.3% to 34.8%. The proportion of cases diagnosed via an emergency presentation route decreased from 25.1% in 2020 to 23.9% in 2021.  

• The distribution of cases diagnosed by route to diagnosis varied over time for specific cancer types. Those demonstrating significant changes between 2020 and 2021 were female breast cancer, colorectal cancer, lung cancer, prostate cancer and malignant melanoma.  

• For those demonstrating significant changes between 2020 and 2021 the proportion with an emergency presentation route: decreased for female breast cancer from 4.1% in 2020 to 3.2% in 2021; decreased for colorectal cancer from 31.2% in 2020 to 28.5% in 2021; increased for lung cancer from 42.6% in 2020 to 44.4% in 2021; increased for prostate cancer from 8.2% in 2020 to 9.0% in 2021.

Survival 

• For patients diagnosed in 2018-2021 one-year survival from cancer (excluding non-melanoma skin cancer) ranged from 42.1% for those diagnosed via an emergency presentation route to 87.3% for those diagnosed via a red-flag referral route.  

• Two years from diagnosis survival ranged from 32.7% for those diagnosed via an emergency presentation route to 80.6% for those diagnosed via a red-flag referral route.