Across 1,272,681 patients with cancer, a meta-analysis found that a 4-week delay was associated with a higher risk of death for 13 of the 17 treatments studied. Delay does not carry the same weight in every disease, but some situations clearly justify moving faster.
If you are waiting for a diagnosis, a test or a treatment decision, Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
Survival varies sharply with the route to diagnosis
The English health system publishes every year the survival of patients according to how their cancer was found. For colorectal cancer, among cases diagnosed between 2016 and 2020, the gap is this.
| Route to diagnosis | Net 1-year survival |
|---|---|
| Detected through screening | 94% |
| After an urgent referral | 85% |
| After a referral by the family doctor | 82% |
| Found in the emergency department | 54% |
Colorectal cancer, cases diagnosed 2016 to 2020. Source, NHS England, Routes to Diagnosis.
The survival gap reaches 40 points depending on the route to diagnosis. But these four groups are not directly comparable, cancers found in the emergency department are on average more advanced and involve different patients. The gap cannot therefore be put down to delay alone.
Treatment delay, measured across more than a million patients
The reference in this field is a meta-analysis published in the British Medical Journal in 2020, covering 34 studies, 17 treatment indications and 1,272,681 patients. It measures the effect of each 4-week block of delay on overall survival, and finds a significant association for 13 of the 17 indications.
| Indication | Per 4 weeks of delay |
|---|---|
| Neoadjuvant chemotherapy for breast cancer | + 28%, the highest in the set |
| Adjuvant chemotherapy for colorectal cancer | + 13% |
| Breast surgery | + 8% |
| Colectomy | + 6% |
| Adjuvant breast radiotherapy | No effect demonstrated |
Hanna et al., British Medical Journal, 2020. 34 studies, 17 indications, 1,272,681 patients, significant association for 13 of the 17.
An honest clarification is needed. The often-quoted 10% per month is a rounded figure. And for some indications, adjuvant breast radiotherapy for instance, no effect of delay was demonstrated. We quote both.
Survival by stage, useful figures to be read with care
US registries give 5-year relative survival according to how far the disease had spread at diagnosis.
| Cancer | Localised | Metastatic |
|---|---|---|
| Colorectal | 91% | 15.7% |
| Lung | 63.7% | 8.9%, and 53% of cases are found already metastatic |
| Melanoma | 100% | 34.6% |
| Breast | over 99% | 32% |
5-year relative survival by spread at diagnosis. Source, SEER, National Cancer Institute. Read with the caution set out in the next paragraph.
These figures are accurate, but they do not directly measure the benefit of an earlier diagnosis. Part of the gap comes from survival being counted from an earlier date of diagnosis, another part from the fact that slow-growing cancers are more often picked up by screening. We cannot therefore conclude that diagnosing earlier would automatically deliver the 75 points seen between stages in colorectal cancer.
What randomised trials actually demonstrate
The only causal evidence comes from randomised trials, and it is more modest than the stage-by-stage survival gaps, but it is solid.
The NELSON trial, published in the New England Journal of Medicine in 2020, followed high-risk men for 10 years with or without CT lung screening. Lung cancer mortality was reduced by 24%. And the stage shift is striking, in the screened group 46.8% of cancers were at the earliest stage against 6.9% without screening, and 9.4% at metastatic stage against 45.7%.
The NLST trial, published in 2011, found a 20% reduction in lung cancer mortality. The NordICC trial, published in 2022, found an 18% reduction in colorectal cancer incidence after invitation to colonoscopy, with a participation rate of only 42%, and a mortality reduction that did not reach significance.
How long people actually wait
| Region / country | What is measured | Headline figure | Year and source |
|---|---|---|---|
| Europe / OECD | Specialist appointment | 52% wait at least 1 month | 2023, Commonwealth Fund / OECD |
| United Kingdom | Specialist appointment | More than 10% wait more than 1 year | 2023, Commonwealth Fund / OECD |
| Canada | From family doctor to treatment | 30 weeks median; 57.5 weeks in orthopaedic surgery | 2024, Fraser Institute |
| United States | Medical appointment, 15 major metropolitan areas | 31 days on average, up 48% since 2004 | 2025, AMN Healthcare |
| Europe, hip replacement | Median wait before surgery | 209 days Hungary; 343 days Poland; 667 days Slovenia | 2024, OECD |
| Australia | Scheduled surgery | 6% wait more than 1 year; septoplasty, 320 days median | 2024-2025, AIHW |
| Singapore | First public specialist appointment | 35 days median (subsidised); 12 days non-subsidised | 2024, Ministry of Health Singapore |
Two of these sources have a commercial or campaigning interest, the Fraser Institute and AMN Healthcare. We name them rather than writing “the statistics show that”.
Why delay and survival are not the same thing
There is a well-documented paradox. In several cancers, the patients diagnosed fastest are also those whose disease is the loudest, therefore the most aggressive. A systematic review of 177 articles shows that only 7 studies account for it. A correlation between delay and survival is therefore never proof that delay alone is the cause, and we will not present it as one.
What we can arrange, and what we do not promise
In practical terms, if this applies to you
Where you are waiting for a diagnosis, a test or a treatment decision, the records you already have can be reviewed before you arrive. In Brussels, the consultations and tests that matter are grouped together, according to your situation, over 24 to 48 hours. The results are brought together and the next steps are arranged. Where a procedure is medically indicated, the surgical stage can be prepared with a target of 7 days after the check-up, when your medical condition allows.
Need medical advice quickly? For a concern that does not call for emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the assessment pathway.
If you have a sudden sign, chest pain, sudden breathing difficulty, weakness on one side of the body, difficulty speaking, loss of consciousness or heavy bleeding, call your local emergency services immediately. No scheduled work-up replaces an emergency.
Further reading
The two companion articles.
Who” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/who-performs-your-examination-changes-what-it-finds/”>Who performs your examination changes what it finds
How” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/how-we-build-a-health-assessment/”>How we build a health assessment, and what we refuse to put in it
Sources
Hanna TP et al., Mortality due to cancer treatment delay, systematic review and meta-analysis, British Medical Journal, 2020. https://www.bmj.com/content/371/bmj.m4087
NHS England, National Disease Registration Service, Routes to Diagnosis, cancers diagnosed 2016 to 2020. https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/routes-to-diagnosis
Surveillance, Epidemiology and End Results Program, National Cancer Institute, Cancer Stat Facts, 2014 to 2020. https://seer.cancer.gov/statfacts/
de Koning HJ et al., Reduced Lung-Cancer Mortality with Volume CT Screening, NELSON trial, New England Journal of Medicine, 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa1911793
Aberle DR et al., Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening, NLST trial, New England Journal of Medicine, 2011. https://doi.org/10.1056/NEJMoa1102873
Bretthauer M et al., Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death, NordICC trial, New England Journal of Medicine, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Neal RD et al., Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes, British Journal of Cancer, 2015. https://www.nature.com/articles/bjc201548
Fraser Institute, Waiting Your Turn, Wait Times for Health Care in Canada, 2025. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
Direction de la recherche, des études, de l’évaluation et des statistiques, Études et Résultats, 2018. https://drees.solidarites-sante.gouv.fr/sites/default/files/2020-08/er1085-2.pdf