KEY POINTS
- The proportion of lung cancers diagnosed at stage I–II in England increased from approximately 30% in 2021 to 40% in 2024, reflecting expansion of screening, public awareness, and diagnostic pathways.
- Among patients with stage I–II non-small cell lung cancer and performance status 0–2, the eligible population increased from 6,767 in 2019 to 11,330 in 2024. The number receiving curative-intent treatment rose by 61%, from 5,561 to 8,936.
- Curative-intent radiotherapy increased from 1,653 patients in 2019 to 2,820 in 2024, while surgery increased from 3,908 to 6,116. Radiotherapy accounted for 32% of all curative-intent treatments in 2024.
- Overall, 78.9% of eligible patients received surgery or radical radiotherapy in 2024, slightly below the National Lung Cancer Audit standard of 80%, despite the large absolute increase in patients treated.
- The recommended interval from referral to curative radiotherapy is 49 days, but the median interval in England was 98 days in 2024, with an interquartile range of 77–129 days. Only 3.2% of patients started treatment within the target.
- Wales showed a similarly prolonged median interval of 97.5 days, with an interquartile range of 81.5–131.5 days, indicating that the capacity problem was not confined to England.
- Adjusted curative-treatment rates varied from 68.8% to 90.7% across cancer alliances. Differences of this magnitude are unlikely to reflect case mix alone and may indicate unequal access to surgery, SABR, workforce, and treatment infrastructure.
CLINICAL TAKEAWAY
Earlier diagnosis is rapidly increasing the number of patients eligible for curative lung radiotherapy, but treatment capacity has not kept pace. The audit does not prove that delays caused worse outcomes, yet a median wait nearly twice the recommended target creates a credible risk that screening gains will be lost through progression before treatment.