Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers
British Journal of Cancer
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Abel, G., Shelton, J., Johnson, S., Elliss-Brookes, L., & Lyratzopoulos, G. (2015). Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. British Journal of Cancer, 112 S129-S136. https://doi.org/10.1038/bjc.2015.52
Background: Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer. Methods: Data from the Routes to Diagnosis project on 749 645 patients (2006–2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined. Results: The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39–1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32–0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35–44- vs 65–74-year-olds, 2.01; 95% CI 1.76–2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin’s lymphoma (e.g., melanoma specific odds ratio in 35–44- vs 65–74-year-olds, 0.20; 95% CI 0.12–0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers. Conclusions: Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.
emergency, diagnosis, route, age, sex, deprivation, inequalities
We acknowledge the authors of previous studies that led to the creation and curation of the Routes to Diagnosis project and data set. The work presented here is a collaboration between Public Health England’s National Cancer Intelligence Network and the Cambridge Centre for Health Services Research of the University of Cambridge. GL was supported by a post-doctoral fellowship by the National Institute for Health Research (PDF-2011-04-047) to the end of 2014 and by a Cancer Research UK Clinician Scientist Fellowship award (A18180) from 2015.
External DOI: https://doi.org/10.1038/bjc.2015.52
This record's URL: https://www.repository.cam.ac.uk/handle/1810/248041
Attribution 2.0 UK: England & Wales
Licence URL: http://creativecommons.org/licenses/by/2.0/uk/
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