Cancer patients in Northern Ireland far less likely to survive if diagnosed through emergency admission, new data reveals

Cancer patients in Northern Ireland are significantly less likely to survive if their illness is first detected during an emergency hospital admission rather than through planned referral routes, according to newly released data covering diagnoses between 2018 and 2022.

Figures published today (Wednesday 29 April 2026) by the Northern Ireland Cancer Registry at Queen’s University Belfast show stark differences in survival outcomes depending on how patients enter the healthcare system, with one-year survival as low as 42.0% for emergency diagnoses compared to 87.6% for those referred through GP “red-flag” suspected cancer pathways.

The data provides one of the clearest pictures to date of how diagnostic pathways directly shape outcomes, highlighting the life-saving importance of early detection and timely referral.

How cancer is being diagnosed across Northern Ireland

Across all cancers analysed (excluding non-melanoma skin cancer), just over a third of patients – 34.4% – were diagnosed following a GP red-flag referral, where cancer is suspected and urgent investigation is triggered.

However, nearly a quarter of cases – 23.0% – were only identified after patients presented to hospital as emergency inpatients, often indicating later-stage disease or more severe symptoms.

Other diagnostic routes included:

• 18.6% referred by GPs to outpatient clinics without red-flag suspicion

• 11.8% diagnosed following outpatient appointments not initiated by a GP

• 5.9% diagnosed through screening programmes

• 2.3% via elective inpatient appointments

• 0.4% identified only through death certificate records

• 3.6% with no available diagnostic route data

These figures underline how a substantial proportion of cancers are still being detected outside the most effective early-warning pathways.

Survival gap exposes impact of late diagnosis

The difference in survival outcomes between routes to diagnosis is pronounced and consistent.

For patients diagnosed between 2018 and 2022:

• One-year survival was 87.6% following a red-flag referral, compared to just 42.0% after emergency presentation

• Two-year survival stood at 81.2% for red-flag referrals but dropped to 32.5% for emergency diagnoses

The data reinforces the link between earlier detection and improved survival chances, with emergency presentations closely associated with poorer outcomes.

Stage at diagnosis closely tied to how cancer is found

The report highlights a strong relationship between diagnostic route and the stage at which cancer is identified.

Early-stage cancers were far more likely to be detected through planned pathways:

• 37.9% of stage I cancers were diagnosed via red-flag referral

• 12.3% were identified through screening

By contrast, late-stage cancers were heavily associated with emergency diagnosis:

• 43.4% of stage IV cancers were diagnosed following emergency admission

• Only 27.6% of stage IV cases came through red-flag referrals

• Just 0.5% were detected via screening

This pattern was evident across multiple cancer types. For example:

• 56.8% of stage IV lung cancers were diagnosed through emergency routes, compared to 20.8% at stage I

• 48.5% of stage IV colorectal cancers were diagnosed via emergency admission, compared to 5.7% at stage I

• 33.9% of stage IV breast cancers were emergency diagnoses, versus 1.8% at stage I

Emergency diagnosis more common among older and deprived populations

The likelihood of being diagnosed via an emergency route rises sharply with age and social deprivation.

Among patients aged 75 and over, 31.1% were diagnosed following emergency presentation, compared to 17.0% among those aged under 65.

Similarly, emergency diagnosis rates were higher in:

• The most deprived areas (25.8%) compared to the least deprived (20.8%)

• Urban areas (24.3%) compared to rural areas (21.0%)

In contrast, red-flag referrals were more common among younger patients, accounting for 37.3% of diagnoses in those aged 0 to 64, compared to 31.0% in those aged 75 and over.

Screening played a limited role overall, particularly among older populations, accounting for just 0.7% of diagnoses in those aged 75 and over.

Screening programmes show strong early detection impact

Where screening programmes are available, they are delivering significantly earlier diagnoses.

Among eligible age groups:

• 52.7% of female breast cancer patients aged 50 to 70 were diagnosed through screening

• 44.1% of cervical cancer patients aged 25 to 64

• 24.3% of colorectal cancer patients aged 60 to 74

Colorectal cancer screening in particular showed strong gains:

• Screening referrals accounted for 10.1% of all colorectal cancer cases

• Among screening-age patients, this rose to 24.3%

Early-stage detection through screening was markedly higher:

• 46.3% of stage I colorectal cancers in screening-age patients were detected via screening

• Only 6.2% of stage IV cases were identified this way

The number of colorectal cancer cases diagnosed via screening increased by 31.5%, rising from 143 cases in 2021 to 188 in 2022.

As a proportion of all cases:

• Screening diagnoses rose from 10.2% in 2021 to 13.3% in 2022

• Among screening-age patients, this increased from 25.1% to 30.7%

Survival outcomes reflected this shift, with one-year survival reaching 98.6% for colorectal cancers detected through screening, compared to 59.3% for those diagnosed after emergency presentation.

Wide variation across cancer types

The likelihood of diagnosis through red-flag referral or emergency presentation varies significantly depending on cancer type.

Red-flag referrals accounted for:

• 60.9% of uterine cancer diagnoses

• 59.9% of malignant melanoma cases

• Just 7.7% of gallbladder and biliary cancers

• Only 1.7% of brain and central nervous system cancers

Emergency admissions were most common for:

• Brain and central nervous system cancers (62.3%)

• Gallbladder and biliary cancers (60.8%)

Among the four most common cancers:

• 50.6% of prostate cancers were diagnosed via red-flag referral

• 46.9% of female breast cancers

• 35.2% of colorectal cancers

• 21.2% of lung cancers

Emergency diagnosis remained particularly high for lung cancer at 41.2%, followed by colorectal cancer at 27.3%.

Recent trends show modest improvement

The latest data suggests some gradual improvement in diagnostic pathways.

Between 2021 and 2022:

• Red-flag referrals increased from 35.2% to 37.3%

• Emergency diagnoses decreased from 23.7% to 22.2%

Significant reductions in emergency presentations were recorded across several cancer types:

• Colorectal cancer fell from 28.5% to 25.0%

• Lung cancer from 44.5% to 40.2%

• Prostate cancer from 8.8% to 7.2%

• Upper gastrointestinal cancer from 31.9% to 27.4%

• Urinary cancer from 21.7% to 20.1%

Cancer Strategy aims to reshape diagnosis pathways

The data release forms part of wider efforts under Northern Ireland’s Cancer Strategy, launched by the Department of Health in March 2022, which sets the direction for cancer services through to 2032.

A key action within the strategy is the establishment of routine reporting and analysis of routes to diagnosis, allowing health services to monitor trends and improve patient pathways.

The current project, developed by the Northern Ireland Cancer Registry with Department of Health support, builds on earlier pilot work in 2020 using data from 2012–2016 and aligns with similar programmes operating in England since 2012.

By classifying every registered cancer case into one of eight diagnostic routes, the system provides a detailed framework for identifying where delays occur and where earlier intervention could improve outcomes.

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At a glance

• 23.0% of cancers in Northern Ireland are diagnosed through emergency hospital admission

• One-year survival is 42.0% for emergency diagnoses vs 87.6% via red-flag GP referrals

• 43.4% of stage IV cancers are diagnosed through emergency routes

• Screening detects over half of breast cancers in eligible age groups

• Emergency diagnosis is more common in older, urban and deprived populations

• Red-flag referrals increased slightly between 2021 and 2022

• Emergency presentations decreased across several major cancer types

• Colorectal screening diagnoses rose by 31.5% in one year

• One-year survival for screened colorectal cancer reaches 98.6%