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Cancer Research UK do a great job in presenting cancer data drawn from the Office of National Statistics. The data on CUP is now presented in a very visible way. You can view it here. You need to remember that the data are for the latest year available and this is 2014.
The main points are:
Comment. Based on the 2014 figures, 1 in 64 people in the UK will be diagnosed with CUP during their lifetime. It is a much bigger ‘problem’ than many clinicians and the general public recognise. CUP remains as the 5th highest attributed cause of UK cancer deaths after Lung, Bowel, Breast and Prostate cancers. There is positive news in that incidence and mortality are declining and we would expect this trend to continue and, in the case of incidence, accelerate. The discrepancy where mortality exceeds incidence each year is probably unique to CUP. There are various possible explanations but one logical explanation is that for elderly patients, presenting with an uncertain cancer and co-morbidities, it is inappropriate to try and determine site specificity through invasive or uncomfortable testing. Therefore, it may be a ‘diagnosis of convenience’ for death certificate recording. The advent of the NICE Guideline on CUP in 2010, that has led to improved diagnostic processes, is probably having an impact on the decline in incidence as are improved imaging techniques. Our view is that the decline is far too slow and that the use of multidimensional tumour profiling – histopathology + molecular profiling – early in the patient pathway would be cost effective and reduce CUP to all but the most intractable cases very rapidly. The standard treatment for the UK patient is based on the pathology of the tumour (from the biopsy) plus the clinical features. Molecular Profiling (presently not funded by the NHS) is increasingly viewed as a valid indicator of the cancer’s characteristics helping to target therapy where there is uncertainty in the standard work-up.