Early stage at diagnosis
Updated 25 May 2022
Applies to England
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This publication is available at https://www.gov.uk/government/publications/be-clear-on-cancer-first-national-cervical-screening-saves-lives-campaign/early-stage-at-diagnosis
This is one of a series of summaries produced for the campaign, each focusing on a different evaluation measure (referred to as a metric) which reflects a key point in the patient pathway. These metrics should not be considered in isolation. Please refer to the considerations when interpreting these results.
Main finding
There is no evidence to suggest the first national ‘Cervical Screening Saves Lives’ campaign increased the proportion of early stage cervical cancers.
Background
This metric considers whether the first national ‘Cervical Screening Saves Lives’ campaign had an impact on the proportions of cervical (ICD-10 C53) and uterine (ICD-10 C54-C55) cancers diagnosed at an early stage in women.
We might expect to see an increase in the proportion of cervical cancers diagnosed at early stage if the campaign increased general awareness of cervical cancer among women of screening age, and encouraged more women to attend for screening.
Methods
Data was extracted from the national cancer analysis system for the diagnosis period January 2018 to December 2019. The data was grouped into weeks and adjusted to account for bank holidays. Analyses considered the proportion of early staged cancers diagnosed in the analysis period compared with the proportion diagnosed in the same period the year before. Early stage was defined as stages 1 or 2 for all ages and for the two screening age groups: 25 to 49 years (invitations every 3 years) and 50 to 64 years (invitations every 5 years).The analysis period was from 18 March 2019 to 27 October 2019. The comparison period was between 19 March 2018 and 28 October 2018. A likelihood ratio test was used to calculate the p-value for statistical significance between the two periods.
Results
Figure 1 below shows the proportion of early staged cervical and uterine cancers per week for women of all ages, with weekly variability from January 2018 to December 2019.
Figure 1: Proportion of early staged cervical and uterine cancers, January 2018 to December 2019, England, women all ages combined.
Figure 2 below shows the proportion of early staged cervical cancers per week for women aged 25 to 49 years and 50 to 64 years from January 2018 to December 2019. There is weekly variation in the proportion of early staged cervical cancers with a decrease around and after the campaign.
Figure 2: Proportion of early staged cervical cancers, January 2018 to December 2019, England, women aged 25 to 49 years and 50 to 64 years
The proportions of early staged cervical and uterine cancer were the same as, or lower, in 2019 compared to 2018, for all ages combined (Figure 1).
For all ages combined, the proportion of early staged cervical cancers decreased by 1.8% (81.2% in 2018 to 79.4% in 2019; p=0.222) (Figure 1). For uterine cancers, for all ages combined the proportion of early staged cancers decreased by 0.5% (81.0% in 2018 to 81.5% in 2019; p=0.486) (Figure 1). These changes are not statistically significant.
For those aged 25 to 49 years, the proportion of early staged cervical cancers decreased by 3.3% (91.1% in 2018 to 86.8% in 2019; p=0.032) (Figure 2). This is a statistically significant decrease.
For those aged 50 to 64 years, the proportion of early staged cervical cancer decreased by 1.3% (74.2% in 2018 to 72.9% in 2019; p=0.723) (Figure 2). This change is not statistically significant.
Conclusion
The first national cervical screening campaign appears to have had no impact on the proportion of cervical and uterine cancers diagnosed at an early stage, for all ages. There was a decrease in the proportion of cervical cancers diagnosed at an early stage for women aged between 25 and 49 years. The increase of cases diagnosed as CIN3 or CGIN (cervical carcinomas in situ) during the analysis period, means a reduction of cases that could have progressed to stages 1 or 2 and that may partially explain the reduced numbers of early staged diagnosed cancers.
Get advice on the signs and symptoms of cancer from the NHS website. You can also find out more about the evaluation of Be Clear on Cancer campaigns.