Our reports and publications

COVID-19’s effect on cancer patients is a key concern to the cancer community with delayed or decreased diagnosis, tests and treatment. To understand this variable and rapidly changing landscape the Cancer Intelligence team are regularly monitoring published data around the impact of the pandemic across the cancer pathway. We have prepared some key insights which reports latest data across the UK (and where possible for the devolved nations) on screening, urgent suspected referrals, diagnostic tests and treatment. 

Cancer Intelligence Team, Cancer Research UK. Performance measures across the cancer pathway: Key Stats Updated October 2024

The CRUK Cancer Intelligence Team’s Cancer Waiting Times and Diagnostic Activity Data Hub gathers the latest data from across the UK on cancer waiting times performance and diagnostic activity and waiting times. You can view breakdowns for some of this information by a specific cancer site and country.

NHS England has a target that at least 85% of patients should start their first treatment for cancer within 62 days of an urgent GP referral for suspected cancer. However, performance against this target has significantly deteriorated in recent years and the number of patients on this pathway waiting over 104 days has been increasing in recent years.​

NHS England release monthly data summarising performance against Cancer Waiting Times (CWT) targets. However, these releases do not provide demographic breakdowns or allow an understanding of why lengthy waits are occurring. This project has used the detailed CWT dataset and the Rapid Cancer Registration Dataset to look at the demographics and other characteristics associated with patients who waited longer than 104 days in 2017/2018, 2020/2021, 2021/2022 and the first two quarters of 2022/2023, and the reported reasons for delay, to inform efforts to reduce the variation in long-waits and decrease their frequency overall, to ensure all patients receive timely treatment. ​

Wills, L. Cancer Intelligence Team, Cancer Research UK:

Breast cancer supplementary analysis  Cancer of unknown primary supplementary analysis  Gynaecological cancer supplementary analysis  Haematological cancer supplementary analysis  Head and neck cancer supplementary analysis  Lower GI cancer supplementary analysis  Lung cancer supplementary analysis  Sarcoma supplementary analysis  Skin cancer supplementary analysis  Upper GI cancer supplementary analysis  Urological cancer supplementary analysis 

This research report from Telstra Health UK and Cancer Research UK explores the potential impact of the COVID-19 pandemic on cancer surgery and cancer mortality, both at the very beginning and throughout 18 months of living with the disruption, fear, and strain. The analysis reveals a general decrease in patients undergoing cancer surgery at the start of the pandemic for all demographic groups, but shows that for the most part the recovery period of the COVID-19 pandemic has not exacerbated inequalities in access to cancer surgery. However we know that there are disparities in access to treatment particularly by age, as well as some evidence of variation by deprivation and region. The report also highlights changes in cancer mortality and place of death. Overall it is shown that there was a profound and sustained impact on cancer services and patients but the true extent of these effects is not yet fully understood.

View the report here

Cancer Research UK (CRUK), The National Cancer Research Institute (NCRI) and Public Health England’s National Disease Registration Service (PHE NCRAS) hosted a Cancer/COVID-19 Research Summit with researchers from different disciplines to identify key research themes or questions around COVID-19’s impact on cancer prevention, early diagnosis and screening. Also, to discuss how the impact of COVID-19 on cancer patients can be mitigated through effective research.

Several areas in which further research is needed were identified, as well as lessons from the pandemic to improve research, cancer care, and help prepare for future crises. These include understanding the biological and psychological effects of COVID-19 on cancer patients, risk factors associated with COVID-19 and cancer, the influence of COVID-19 on health-related behaviours and the impact of COVID-19 on cancer care pathways. The full meeting report can be found here.

This report summarises the findings from the CRUK patient experience survey (PES), which collected data from 1st May to 28th May 2020. The findings indicate the impact of COVID-19 on cancer patients, and their testing, treatment and care. For many cancer patients the COVID-19 pandemic appears to have had a significant impact on their testing and treatment, and most notably their care. This has resulted in a negative impact on the emotional well-being of many cancer patients whether they were hoping to finish their treatment, find out the results of their test, have their regular screening, or continue with care that could support them, in some cases for the remainder of their life.

Cancer Research UK. Cancer Research UK Cancer Experience Survey 2020: The impact of COVID-19 on Cancer patients in the UK. July 2020. 

Our CRUK-PHE partnership team have investigated the geographic variation in the use of lymphonodectomy and external beam radiotherapy (EBRT) in the treatment of endometrial cancer. Significant variation was found between 19 Cancer Alliances using population level cancer registry data collected between 2013-2016, which is likely due to ambiguity in existing endometrial cancer management guidelines. 

White B, Nordin A, Fry A et al. Geographic variation in the use of lymphadenectomy and external‐beam radiotherapy for endometrial cancer: a cross‐sectional analysis of population‐based data. BJOG 2019 doi: 10.1111/1471-0528.15914

Our CRUK – NHS England partnership team have investigated variation in concordance to recommendations from NICE treatment guidelines for colon and non-small cell lung cancer by patient characteristics and Cancer Alliance. Concordance differed between the recommendations, but there were generally associations between age group, comorbidity score, and stage and the likelihood of receiving recommended treatment.

Wills, L. Cancer Intelligence Team, Cancer Research UK:

Non-small cell lung cancer treatment guideline recommendation concordance report

Colon cancer treatment guideline recommendation concordance report

Smoking is the biggest cause of cancer and death in the UK. Estimates of the population-level burden of smoking-attributable cancer are useful to galvanise policymakers to try to reduce smoking rates. This analysis brief presents estimates of the total number of cancer cases expected to be caused by smoking over the current parliamentary term in the UK, and for the same time period in each of the devolved nations.

The projected number of smoking-attributable cancer cases in the UK from July 2024 – July 2029 was estimated using the well-established population attributable fractions (PAFs) method. The analysis dataset was compiled from projected cancer incidence based on gold-standard cancer registration data, representative population surveys of self-reported smoking and smoke exposure, and meta- or pooled analyses examining the relative risk of cancer in people who currently smoke, used to smoke, or have been exposed to other people’s smoke, versus people who have never smoked or been exposed. Analysis was split by cancer site, sex, age-band, and UK nation, and combined to obtain UK-wide figures.

The results find that almost 300,000 cancer cases are projected to be caused by smoking in the current parliamentary term in the UK. Around 2,800 of these cases are expected to be caused by secondhand smoke exposure in people who have never smoked.

Smoking is the leading cause of cancer and preventable death in the UK. Smoking prevalence has been declining across the UK for some decades, yet there are still around 4.9 million people who smoke in England and around 60,800 tobacco-attributable deaths every year. Smoking prevalence remains higher in more deprived groups. In 2019 the UK Government set a smokefree ambition to achieve 5% average adult smoking prevalence by 2030 in England. There is currently no ambition to achieve smokefree in all deprivation groups.

In this report we estimate whether the smokefree 2030 ambition is likely to be realised based on recent trends, and when smokefree will be achieved for each deprivation decile. We have projected average adult smoking prevalence, and smoking prevalence by deprivation decile, for England until 2050. These projections use smoking prevalence data up to 2023 from the Office for National Statistics’ Annual Population Survey.

The results suggest that if recent trends continue, England will not reach Smokefree until 2039, almost a decade behind target. Adult smoking prevalence in the least deprived decile in England is projected to reach 5% in 2025, while in the most deprived decile, adult smoking prevalence will not fall below 5% by 2050. Only the least deprived two deciles (deciles 9 and 10) are estimated to reach the 5% smokefree threshold by 2030. The findings are similar to our previous projections using data to 2021.

Smoking is the biggest cause of cancer and death in the UK. It causes at least 16 types of cancer. Smoking prevalence in the UK has been falling for decades; however, the pace of change has varied by sex and age (among other characteristics), and people who used to smoke also have elevated cancer risk compared with people who have never smoked.

The number and proportion of smoking-attributable cancer cases in the UK in 2003, 2013, and 2023 were calculated using the well-established population attributable fractions (PAFs) method. The analysis dataset was compiled from gold-standard cancer registration data, representative population surveys of self-reported smoking and smoke exposure, and meta- or pooled analyses examining the relative risk of cancer in people who currently smoke, used to smoke, or have been exposed to other people’s smoke, versus people who have never smoked or been exposed. Analysis was split by cancer site, sex, age-band, and UK nation, and combined to obtain UK-wide figures.

The results find that the estimated proportion of UK cancer cases attributable to smoking has decreased over the past two decades, from 17% in 2003 to 14% in 2023. The estimated number of smoking-attributable cases has increased over this period, from around 48,900 in 2003 to around 57,800 in 2023. The estimated proportion of cancer cases attributable to smoking in 2023 was higher in males (16%) than females (13%), and highest within the UK nations in Scotland. 63% of all UK smoking-attributable cancer cases in 2023 were lung cancer (around 33,100).

Smoking is the leading cause of cancer and preventable death in the UK. Smoking prevalence has been declining across the UK for some decades, but remains higher in more deprived groups. The UK Government has set a smokefree ambition (to achieve 5% average adult smoking prevalence) for 2030 in England. There is currently no ambition to achieve smokefree in all deprivation groups.

In this report we estimate whether the smokefree 2030 ambition is likely to be realised based on recent trends, and when smokefree will be achieved for each deprivation decile. We have projected average adult smoking prevalence, and smoking prevalence by deprivation decile, for England until 2050. These projections use smoking prevalence data up to 2021, from the Office for National Statistics’ Annual Population Survey.

The results suggest that if recent trends continue, England will not reach smokefree until 2039, and to achieve the 2030 smokefree target, the pace of change needs to be around 70% faster than projected. The most deprived tenth of the population In England may be almost three decades behind the least deprived tenth, in achieving 5% smoking prevalence. This analysis suggests the pace of decline in smoking prevalence has slowed overall, and the deprivation gap has widened, since our previous projections using data to 2018.

Smoking is the leading cause of preventable cancer and death in the UK. Deprived populations typically experience higher rates of smoking and cancer incidence. We calculated the proportion and number of smoking-related cancer cases by deprivation quintile in England and modelled how smoking contributes to the deprivation gap for cancer incidence. We found a strong deprivation gradient for the proportion of cancer cases attributable to smoking in England. Our modelling suggests that more than half (61%) of the deprivation gap for cancer incidence could have been prevented if nobody smoked, indicating smoking to be the key driver for cancer incidence inequality in England.

Payne NWS, Brown KF, Delon C et al. Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking. PLOS ONE 2022 17(9): e0272202

Overweight and obesity is a major risk factor for the leading causes of death in the world and is causally associated with at least 13 different types of cancer. Overweight and obesity prevalence has increased markedly in the UK in recent decades. We provide projections for overweight and obesity prevalence by sex and deprivation quintile in the UK (where possible) and its constituent nations. These projections, based on current trends in nationally representative health surveys, suggest that there could be more people who are obese than healthy weight in the UK by 2040. In England and Scotland, the deprivation gap for obesity between the least and most deprived is projected to increase by more than half.

The CRUK-PHE partnership have published a paper comparing patients presenting with non-specific but concerning symptoms with patients presenting with more obvious symptoms. Cancer registration data was linked to the National Cancer and Diagnosis Audit (NCDA) data, which has information about primary care for over 17,000 cancers. The work found that patients with non-specific symptoms had longer primary care intervals, more complex diagnostic pathways and were more likely to be diagnosed at stage 4 and after an emergency presentation. This work supports the evaluation of Multi-Disciplinary Centres (MDCs) by the ACE Programme, an early diagnosis imitative supported by CRUK, MacMillan Cancer Support and NHS England.

Pearson C, Poirier V, Fitzgerald K, et al. Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms. BMJ Open 2020;10:e033008. doi: 10.1136/bmjopen-2019-033008

This report investigates to what extent the proportion of overweight and obesity attributable cancer cases in the UK varies with deprivation. For females, the proportion of cancer cases attributable to overweight and obesity showed a 10-29% relative increase from the least deprived quintile to the most deprived. The deprivation gap was generally much smaller for males. There is a stronger deprivation gradient for obesity prevalence in UK females compared to males, and more overweight and obesity-associated cancer types in females compared to males, which explains the differences observed between sexes.

Cancer Intelligence Team, Cancer Research UK. The fraction of cancer attributable to overweight and obesity by deprivation quintile in the UK. October 2020.

UK smoking prevalence has been declining overall for some decades, and ambitions to achieve 5% average adult smoking prevalence (‘smoke-free’) have been set by England for 2030, and Scotland for 2034. These projections, based on current trends in nationally-representative smoking surveys, suggest that 5% average adult smoking prevalence could be reached in 2037 for England and Wales, the late 2040s for Northern Ireland, and after 2050 for Scotland. There could be millions fewer UK smokers than projected in the 2030s, if smoke-free ambitions were achieved; however to do this the pace of change needs to increase markedly in all UK nations. Socioeconomic inequalities are a key concern: the projections indicate that in England, smoke-free could be achieved by the most deprived fifth of the population around 20 years later than in the least-deprived fifth; and in Scotland and Northern Ireland this deprivation gap may be markedly longer.

Cancer Intelligence Team, Cancer Research UK. Smoking prevalence projections for England, Scotland, Wales, and Northern Ireland based on data to 2018/19. February 2020.

The proportion of current smokers in the population (smoking prevalence) has been falling for decades in the UK, However a clear deprivation gradient remains: smoking prevalence is around twice as high in routine and manual (R&M) workers compared with managerial and professional (M&P) workers. That gap has widened in recent decades, because smoking prevalence has fallen more slowly among R&M workers compared with M&P workers. This reflects both higher rates of uptake and lower rates of quitting in R&M workers compared with M&P workers. Occupation group is associated with smoking behaviour independent of other characteristics like age, sex, region, education, marital status, ethnicity, alcohol consumption and general perceived health. If the R&M worker population had experienced the same pace of decline in smoking prevalence as the M&P population, there would now be almost a million fewer R&M worker smokers.

Cancer Intelligence Team 2019 Smoking prevalence trends by occupation group in health survey for England

Our CRUK-NHS E partnership team have evaluated whether certain ethnic groups in England are more likely to be diagnosed at a later stage. Reviewing diagnoses of 6 cancer types from 2012-2016 in people belonging to one of 5 ethnic groups, we found that Caribbean, African and Asian women and Caribbean men had increased odds of late-stage disease for certain cancer types compared to the White British cohort. Reasons behind increased late diagnoses may include poorer symptom awareness, delays in seeking help and having to present to the GP multiple times before being referred for tests.

Fry A, White B, Nagarwalla D, et al. Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites. BMJ Open 2023. doi: 10.1136/bmjopen-2022-062079

In partnership with the National Cancer Registration Services (NCRAS), we have produced 10 year survival by stage estimates for the East of England. 10 year survival gives cancer patients a more accurate reflection of their long term survival experience and this work focuses on the differences in survival by stage at diagnosis. The work highlights the need for continued efforts to achieve diagnosis at earlier stages to improve longer term cancer outcomes. The results for lung, breast, bowel and prostate cancer are shown indicating 10 year survival is much poorer when diagnosed at the latest stage compared to the earlier stages. More information about the method used and wider range of site estimates produced can be found in this technical report. 

See the infographic here

Our CRUK-PHE partnership team have calculated diagnostic intervals for the first time for patients of 25 different cancer sites diagnosed in 2014 & 2015. Significant variation in these intervals were found by stage of disease, route to diagnosis and comorbidity score. An online tool demonstrates variation by these and other factors  by cancer site and cancer alliance. A paper describing the methodology and results for colorectal and lung cancer was published in Cancer Epidemiology in June 2019. Two blogs detailed the project, one by CRUK and one at Public Health Matters. 

Pearson C, Fraser J, Peake M. Establishing population-based surveillance of diagnostic timeliness using linked cancer registry and administrative data for patients with colorectal and lung cancer. Cancer Epidemiology 2019.

This report sets out the key challenges facing cancer services and people affected by cancer. We’ve made huge progress on cancer in the last 50 years, but new analysis indicates that improvements in survival have slowed. This next instalment in the Cancer in the UK series highlights the need for political leadership to deliver long-term solutions to the challenges facing cancer research and care. 

Cancer in the UK: Overview 2024

Devolved nation summaries are also available:

Cancer in the UK: Scotland Overview 2024

Cancer in the UK: Wales Overview 2024

Cancer in the UK: Northern Ireland Overview 2024

This report sets out the top line view of key challenges facing cancer services, and people affected by cancer today, looking at where progress is being made and the many challenges we face. With cancer cases projected to rise, ensuring we have a long term, comprehensive plan for cancer that tackles these challenges and harnesses the opportunities is vital.

This report is a call to action – all of us must come together to make progress in our ambition to beat cancer. People affected by cancer deserve no less.

Cancer in the UK: Overview 2023

Devolved nation summaries are also available:

Cancer in the UK: Scotland Overview 2023

Cancer in the UK: Wales Overview 2023

Cancer in the UK: Northern Ireland Overview 2023

This report focuses on the impact of deprivation across the cancer pathway in Scotland. Generally, populations with higher deprivation have greater risk factors for cancer, are less aware of symptoms of cancer and report more barriers to seeking help. Their participation in screening programmes is lower and they are more likely to be diagnosed with late-stage disease. People from more deprived populations have worse cancer outcomes, including survival. We need to make sure we push to achieve lower levels of cancer risk factors, better engagement with the health system and improved cancer outcomes for everyone and close the deprivation gap, because beating cancer must mean beating it for everyone.

Cancer Intelligence Team, Cancer Research UK. Cancer in the UK: Deprivation and cancer inequalities in Scotland. November 2022.

This report brings together the available evidence across the UK of inequalities in cancer by socio-economic variation and shows the negative experiences and outcomes that people from more deprived groups experience. Generally, populations with higher deprivation have higher prevalence of cancer risk factors, are less aware of symptoms of cancer and report more barriers to seeking help. Their participation in screening programmes is lower and they have higher proportions of cancer diagnosed through routes with worse survival. People from more deprived populations report worse experiences of care and experience inequalities in treatment options. They have worse outcomes. This report presents the evidence for each part of the cancer pathway with examples from all four UK nations. 

Cancer Intelligence Team, Cancer Research UK. Cancer in the UK 2020: Socio-economic deprivation. September 2020.