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Background Cancer is the leading cause of death in the UK, with socioeconomic inequalities contributing to delayed diagnosis and poorer outcomes. This evaluation examines disparities in referral patterns and mortality across deprivation quintiles in Cwm Taf Morgannwg University Health Board (CTMUHB).Methods Suspected Cancer Pathway (SCP) data from CTMUHB (January 2023–December 2024) were analysed. Referral and mortality rates were calculated using Office of National Statistics (ONS) mid-2019 population estimates. Deprivation was assessed using the Welsh Index of Multiple Deprivation (WIMD) 2019.Results Referral rates into the SCP were lowest in the most deprived quintile (125.8 [95% CI: 123.7-127.9] per 1,000 residents) and highest in the least deprived (163.8 [95% CI: 160.9-166.8] per 1,000 residents) over the two-year period. Mortality rates per 1,000 referrals were significantly higher in the most deprived group (64.7 [95% CI: 60.8-68.9]) compared to the least deprived (46.4 [95% CI: 42.7-50.3). GP referrals accounted for 80% of all SCP referrals, with a similar deprivation gradient where the most deprived: 101.0 [95% CI: 99.1-102.9] vs. least deprived: 133.9 [95% CI: 131.2-136.6] per 1,000 residents. In contrast, referrals from Emergency Departments (ED) showed no statistically significant difference across deprivation quintiles. Although infrequent (1.1 [95% CI: 1.0-1.2] per 1,000 residents), ED referrals were associated with a ten-fold increase in mortality (460.6 [95% CI: 417.7-504.1] vs. 41.3 [95% CI: 39.6-43.1] per 1,000 referrals for GP referrals).Conclusion Significant inequalities exist along the SCP in CTMUHB, with lower referral rates and higher mortality in more deprived areas. ED referrals into the SCP, though rare, are linked to poorer outcomes and greater palliative care needs. These findings highlight the importance of targeted public health interventions to enhance public understanding of cancer symptoms, improve uptake of screening programmes, promote timely access to primary care for early diagnosis and reduce inequalities in cancer outcomes.