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Cancer patients diagnosed early ‘more likely to avoid chemo’

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Cancer patients diagnosed early are far more likely to avoid chemotherapy than those with tumours found at a later stage, according to a major new study based on NHS data.

It represents the most comprehensive study of its kind in the world, linking the stage of cancer diagnosis and treatment for individual patients, said the researchers behind it.

“This data is the most comprehensive of its kind in the world”

Jem Rashbass

Patients were found to be around five times more likely to have surgery, and less likely to have chemotherapy, if they were diagnosed at the earliest stage, compared to the latest stage.

The study – titled Chemotherapy, Radiotherapy and Surgical Tumour Resections in England – is the first time that researchers have been able to show whether NHS patients received surgery, chemotherapy and radiotherapy, alone or in combination, linked with their cancer stage.

Those behind the analysis noted that chemotherapy and radiotherapy were the most appropriate first line treatments for some cancers, but for most types surgery was the most likely way to cure it.

In addition, treating a tumour with surgery alone often minimised the chances of longer term side effects, they said.

The charity Cancer Research UK and government arm’s-length body Public Health England examined data from about half a million patients with 22 different cancer types in England during 2013-14.

It showed that 70% of those diagnosed at stage 1 had surgery to remove their tumour, falling to around 13% of those diagnosed at stage 4.

“We all have our part to play to increase the number of patients diagnosed earlier”

Sara Hiom

In addition, around 12% of patients diagnosed at the earliest stage had chemotherapy, rising to around 39% of those diagnosed at the latest stage.

The researchers also identified different trends for different types of cancer.

For colon cancer, 94% of patients had surgery to remove their tumour when diagnosed at the earliest stage. In contrast, 32% of patients diagnosed with stage 4 disease had surgery.

Meanwhile, just 2.7% of colon cancer patients with stage 1 disease had chemotherapy, compared to 47% diagnosed at stage 4.

For breast cancer, 95% of those diagnosed at stage 1 and 25% diagnosed at stage 4 had surgery. Those diagnosed at stage 4 were more than twice as likely to have chemotherapy as stage 1 patients.

For patients with the earliest stage non-small cell lung cancer – the most common type of the disease – 6% had chemotherapy. This compares to 30% when diagnosis is made at the latest stage.

Lead study author Professor Mick Peake, from Public Health England, said: “In most cases, the earlier cancer is diagnosed the more likely it is to be effectively treated by surgery, and that means chemotherapy isn’t always necessary.

“In general, the treatment of cancers at an early stage also reduces the risk of long term side effects which can affect patients’ quality of life,” he noted.

Dr Jem Rashbass, cancer lead at Public Health England, said: “This data is the most comprehensive of its kind in the world, linking stage of diagnosis and treatment for individual patients.

“Its wealth of knowledge will help us to better understand treatment and survival patterns and underpins the importance of early diagnosis and screening,” he said.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “This research shows how important an early diagnosis is for simplifying the treatment options as much as possible.”

She added: “We all have our part to play to increase the number of patients diagnosed earlier.”

The percentage of cancer patients that received surgery, chemotherapy and/or radiotherapy, alone or in combination, for patients diagnosed with the three most common cancers (breast, colon (bowel), and the most common type of lung cancer) by stage.

Cancer typeStageSurgeryChemotherapyRadiotherapy

All cancers

All stages





Earliest stage (stage 1)





Latest stage (stage 4)






All stages





Earliest stage (stage 1)





Latest stage (stage 4)





Colon (bowel)

All stages





Earliest stage (stage 1)





Latest stage (stage 4)





Non-small cell lung cancer

All stages





Earliest stage (stage 1)





Latest stage (stage 4)




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