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• W3100798768 abstract "More precise risk stratification is required to enable timely diagnosis of bowel cancer while avoiding unnecessary investigation, argue Michael Thompson and colleagues UK Department of Health policies to improve survival from bowel cancer through GP referral guidelines and public awareness campaigns have increased urgent referrals to hospitals. This has led to an unsustainable demand for colonoscopy and CT colonography without evidence of significant clinical benefit. These policies could be improved by more precise stratification of the risk of having bowel cancer to achieve prompt, rather than earlier, diagnosis while avoiding over-referral and investigation of patients with transient symptoms from benign conditions. The first UK cancer plan was developed in 2000 to improve outcomes for patients. The plan introduced the concept of the “two week wait,” from urgent GP referral to the first outpatient appointment. In 2000, the committee developing the referral criteria for bowel cancer1 advised that only those with symptoms persisting for 6 weeks should be referred. The 2005 National Institute for Health and Care Excellence ( NICE) review of the guidelines largely endorsed the referral criteria, which identified nine out of 10 bowel cancers (box 1) and had a 9-14% predictive value for cancer34 (table 1). Fast track clinics reduced time to diagnosis but not to treatment.34 Over the following nine years the number of referrals increased by 45% (table 1) while the predictive value for cancer decreased from 14% to 8%34567 (table 1). A review of several articles was carried out in 2001-04, with one study reporting a 14% predictive value for cancer and another, by 2009, before the introduction of the public awareness campaign, reporting a predictive value of 7.9%. Box 1 ### Seven typical characteristics of bowel cancer2 These characteristics identified over 92% of bowel cancers referred to outpatient departments. Adding two age thresholds: >40 … RETURN TO TEXT" @default.
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• W3100798768 date "2020-11-10" @default.
• W3100798768 modified "2023-10-07" @default.
• W3100798768 title "Have large increases in fast track referrals improved bowel cancer outcomes in UK?" @default.
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• W3100798768 doi "https://doi.org/10.1136/bmj.m3273" @default.
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