Patients referred for urgent suspected cancer, but who are found not to have cancer at that time, have a higher risk of subsequent cancer in the 1-5 years following the ‘all clear’ than those not seen in urgent referral pathways. The results suggest that there are unmet needs in the cancer referral pathway for better support on reducing the risks of cancer.
The study published in Lancet Oncology looked at the health data of over a million NHS patients in England who were found not to have cancer following an urgent suspected cancer pathway referral. WIPH researchers in collaboration with colleagues at King’s College London, the University of Oxford and the National Disease Registration Service (NHS England) found that 1-5 years after the initial referral, 63,112 cases of cancers were diagnosed. The risk of any cancer in this group was 4.5% over the 5 years which, while not considered high, is higher than in people of similar age and gender in the general population. The results suggest that the higher than expected cancer risk is not due to cancers being missed in the initial referral, but that the subsequent cancers are likely due to high risk factors, such as poor diet, smoking, or alcohol consumption.
The study included health data on referrals and diagnoses for the eight main urgent suspected cancer referral pathways: breast, gynaecological, head and neck, lower and upper gastrointestinal, lung, skin, and urological. Researchers also looked at which types of cancers occur after different referral pathways. The increased risk of subsequent cancer in the 1-5 years after referral was lowest following suspected gastrointestinal cancer referrals, and highest following suspected urological or lung cancer referrals. For risks of the same cancer as suspected at initial referral, the highest were for the head and neck, and lung pathways.
The urgent suspected cancer referral pathway is the most common route to diagnosis in England, with 3 million patients referred through this system annually, of whom 7% are found to have cancer. This leaves a large and understudied group of patients who go through these pathways but do not have cancer at the time.
The findings suggest that there is an opportunity to provide additional support to patients without a cancer diagnosis on the referral pathway. Proactive monitoring or targeted interventions to support behaviour change, such as cancer awareness or risk reduction initiatives, could be beneficial in reducing the risk of cancer.
Lead author Suzanne Scott said: ‘Going through urgent cancer assessments can be a very anxious time for patients. Thankfully most will not be diagnosed with cancer. In this study we found that having cancer ruled out doesn't lessen the future risk of cancer. This means patients and GPs should remain vigilant when experiencing new or ongoing symptoms. The timing of urgent suspected cancer referrals could be an opportunity to raise cancer awareness, and consider ways to reduce risk of cancer and other serious diseases, by making a positive change in health behaviour.’