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21 September 2021

GP urgent referrals for suspected cancer more than double over ten years

New research has analysed nearly 15 million urgent referrals for suspected cancer in England and found over 1.2 million cancers have been picked up over ten years.

GP showing medication to eldely woman

The paper, published today in the British Journal of General Practice (BJGP) and funded by the National Institute of Health Research (NIHR) at King’s, examined urgent referrals over the last decade.

Yearly referrals have more than doubled to over 2.2 million urgent referrals in 2018/19 leading to 163,000 people diagnosed with cancer, which was over half of all cancers registered in England that year. In total, 66,172 additional cancer cases were picked up following GP urgent referral in 2018/2019 compared to 2009/2010, a 68% increase in cancers picked up. Around 7 in 100 people urgently referred will go on to be diagnosed with cancer.

If a GP or primary care health professional suspects a patient has cancer, they can fast-track refer them to be seen by a specialist or have a specialist test within two weeks. Patients diagnosed with cancer following an urgent referral are likely to have improved outcomes. However, of concern are decreases in urgent referrals seen during the COVID-19 pandemic and potential disparity in cancer detection, with lower rates seen in more deprived populations.

This research supports the increases seen in primary care referrals and access to diagnostic tests, which allows more cancers to be diagnosed and improved patient outcomes. This is a positive message that GPs and primary care teams are working hard utilising referral pathways and implementing NICE referral guidelines.

Dr Thomas Round, lead author and GP Academic Researcher at the School of Population Health & Environmental Sciences

He said: “While we saw a drop in urgent referrals during the height of the pandemic, these have now recovered to pre-pandemic levels. This is a testament to busy GPs and their teams who are delivering over a million appointments every day. The more recent disparity with lower cancer detection in more deprived areas is a cause for concern and reiterates the need for a levelling up agenda and investment in health services particularly in deprived areas.”

1 in 2 people in the UK will be diagnosed with cancer in our lifetimes, with over 360,000 new cases and 165,000 cancer deaths per year in the UK. However similar high-income countries have better cancer survival rates, with potentially 5,000-10,000 avoidable cancer deaths per year in the UK if our survival rates matched those in other countries. Early diagnosis is key to increasing cancer survival rates.

Higher cancer detection was associated with larger practices and those with younger GPs, though the relationship with GP age became less over time suggesting the implementation of NICE urgent referral guidelines into clinical practice.

Dr Round added: “We would encourage anyone with potentially worrying symptoms like abnormal bleeding or lumps to contact their practice for an assessment and not delay.

“In post-pandemic recovery it is crucial to continue to facilitate primary care urgent referrals and support NHS staff delivering these services. This includes significant ongoing investment in primary and secondary care including diagnostic testing capacity to deliver continued improvements to cancer early diagnosis."