A new report from the Endometrial Cancer Audit Pilot (ECAP) offers insight into how women in England are diagnosed with endometrial cancer, alongside trends in the recording of tumour genomic testing and the use of immunotherapy.
Published in May 2026, the third ECAP report builds on earlier analyses of incidence, treatment, and survival. It focuses on three areas of the care pathway: route to diagnosis, tumour genomic testing, and access to newer immunotherapies.
Using linked, routinely collected NHS data, the analysis provides a national picture of care without requiring additional data collection from clinical teams.
Diagnosis routes remain varied
Most women diagnosed between 2017 and 2019 entered care via the urgent “two-week wait” referral pathway, accounting for around 62% of cases. Emergency presentation was less common but still accounted for 7% of diagnoses.
A diagnosis of endometrial cancer following an emergency presentation was more likely among older women, those living in more deprived areas, and patients with higher levels of comorbidity. Differences were also seen between ethnic groups, with highest rates observed among women in the black ethnic group.
As in other cancers, diagnosis of more advanced disease was higher among women diagnosed following an emergency presentation, underlining the importance of early recognition and timely referral.
Growth in tumour genomic testing
The report highlights a marked increase in recorded tumour genomic testing from 2020 onwards. By 2023, around 80% of women had at least one test recorded.
This increase coincides with national guidance and initiatives to expand molecular testing, particularly for mismatch repair (MMR) status. However, the findings should be interpreted with caution, as variation may reflect differences in recorded data completeness as well as clinical practice.
The report emphasises the role of these findings in helping providers assess and improve local data capture.
Gradual uptake of immunotherapy
Use of immunotherapy was relatively low overall but had increased over time. Among women diagnosed between 2017 and 2023, 2.5% had a record of receiving immunotherapy, rising from 1.1% in 2017 to 3.5% in 2023.
This reflects the gradual introduction of newer treatments, particularly indicated for advanced or recurrent disease. While some variation was seen across patient groups, differences between regions were largely explained by patient and tumour characteristics.
Supporting future audit
Overall, the findings in this report, combined with those in the previous two reports, demonstrate how routinely collected data can be used to understand patterns of care and variation across the cancer pathway for women diagnosed with endometrial cancer in England.
The third ECAP report provides further evidence to support service improvement and more consistent care, and is another important step towards a potential future national endometrial cancer audit.
Acknowledgement
This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS England.
For further information about the project see: Endometrial Cancer Audit Pilot (ECAP)