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Late presentation, late diagnosis, late stage diagnosis, delayed diagnosis, delayed presentation: terminology confuses the message in UK cancer policy

BMJ 2012; 344 doi: (Published 02 May 2012) Cite this as: BMJ 2012;344:e3017
  1. Matthew S Day, specialty registrar in public health, Yorkshire and the Humber Specialised Commissioning Group, Barnsley S75 2PY; honorary lecturer in public health, School of Health and Related Research, University of Sheffield
  1. matthew.day2{at}

Cancer survival rates make big headlines. Recently the government has used survival rates as part of the case for the major NHS structural reforms, and it is estimated that up to 10 000 lives a year could be saved in England if we had the best survival rates in Europe.1

So, to catch up with our European neighbours, patients need to be diagnosed earlier. Or do they need to present earlier? Which ever it is, the overall message is clear: the earlier your diagnosis, the better your chances. But less clear is the collection of phrases used when talking about cancer survival, from the media to government policy documents.

To untangle these phrases we need to delve a little deeper. What constitutes an early or late diagnosis of cancer? In the UK, the term “late diagnosis” usually means a late stage tumour, one that is locally advanced or has metastasised. Studies reporting cancer survival will use the TNM (tumour size; spread to lymph nodes; metastasis) staging system to identify these “late stage” tumours. …

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