The Routes to Diagnosis study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised, in order to examine demographic, organisational, service and personal reasons for delayed diagnosis.
Administrative Hospital Episode Statistics data are combined with cancer waiting times data, data from the cancer screening programmes and cancer registration data from the National Cancer Data Repository.
Using these datasets every case of cancer registered in England which was diagnosed in 2006-2010 is categorised into one of eight ‘Routes to Diagnosis’.
The methodology is described in detail in the British Journal of Cancer article Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets, which can be found at the following link and is also attached. http://www.nature.com/bjc/journal/v107/n8/full/bjc2012408a.html
Emergency presentations are defined as “an emergency route via A&E, emergency GP referral, emergency transfer, emergency admission or attendance.” More detail can be found in the attached technical document.
Data on all malignant neoplasms (excluding non-melanoma skin cancer) and pancreatic cancer was taken from the “Routes to diagnosis 2006-2010 workbook (a)” – this can also be found in the attached article.
The Emergency Presentation Route is the principle route to diagnosis for patients with pancreatic cancer. This reflects the lack of easily recognisable symptoms of early disease, with advanced disease often presenting with the acute onset of jaundice.
The percentage of emergency presentations ranges from 3% for melanoma to 63% for acute lymphoblastic leukaemia.
Table 1: Percentage of diagnoses by emergency presentation route, England, persons, 2006-2010
Number of cases
Number of cases by emergency presentation route
Percentage by emergency presentation route
All malignant neoplasms
(excl. non-melanoma skin cancer)