Patients with “red flag” cancer symptoms are not being referred by their GP for urgent investigation in six out of 10 cases, a new study claims.
The research found that a significant number of the patients who were not referred went on to develop cancer within a year of their GP consultation.
Early diagnosis of cancer is known to be a major factor in saving lives.
The study was led by the University of Exeter, working with University College London, and funded by Cancer Research UK.
Dr Gary Abel, who led the research, said: “Over the past decade we’ve made huge progress in improving life-saving cancer diagnosis in the UK, in part thanks to GPs.
“Our study showed that patients who are referred are much more likely to be diagnosed with cancer in the next year than those that are not referred, so GPs are clearly referring the highest risk patients appropriately.
“However, many patients did not receive an urgent referral within two weeks, contrary to guidelines.
“The number of patients who go on to be diagnosed with cancer when they are not urgently referred indicates that following the guidelines more strictly would have significant benefits.
Lead author Dr Bianca Wiering said: “Our research found that a number of patients go on to develop cancer after they were not referred for red flag symptoms.
“This could mean an opportunity to diagnose the cancer earlier was missed. We think this could be improved by stricter adherence to the guidelines and increased awareness of the groups of patients in whom symptoms are frequently missed, including younger patients.
“It’s important to note that this issue does not just lie with GPs – we also need to ensure the services to provide the tests needed on referral are well resourced, which we know is currently not always the case.”
The research team analysed records from nearly 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines.
They found that six out of 10 patients were not referred for cancer investigation within two weeks of the first visit.
Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%).
The researchers processed records from the Clinical Practice Research Datalink, as well as statistics on visits to hospital and cancer registration data between 2014 and 2015.
They looked at patients who had reported cancer warning signs to their GP for the first time.
The “alarm” symptoms included blood in urine, a breast lump, problems swallowing, iron-deficiency anaemia, and postmenopausal or rectal bleeding.
The likelihood of a patient being referred within two weeks varied, depending on which symptom they showed.
The lowest referral rate was for problems swallowing, at just 17%, and the highest was for breast lump, at 68%.
An NHS spokeswoman said: “The data referenced in this study is from 2014-15 and since then, urgent GP referrals for suspected cancer have been rising at around 200,000 each year, reaching 2.4 million last year and at record levels again this year.
“The NHS has continued to prioritise cancer care throughout the pandemic and in July more than 220,000 people were referred for cancer checks, an increase of 45,000 from July 2020 with treatment now back to pre-pandemic rates.”
– The paper, Concordance with urgent referral guidelines in patients presenting with any of 6 ‘alarm’ features of possible cancer: A retrospective cohort study using linked primary care records, is published in the journal BMJ Quality & Safety.