Increased use of urgent suspected cancer referrals associated with improved survival rates

Results of a 5-year national cohort study, involving over 1.4 million individuals with cancer in the UK, suggest that those belonging to the highest referring GP practices were more likely to receive diagnoses for breast, lung and prostate cancers at earlier stages, and face lower mortality rates.

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Published in the British Journal of General Practice, the results of a new analysis led by investigators from King’s College London and Public Health England (both London, UK) suggest that individuals with cancer belonging to the highest referring GP practices in the UK were more likely to receive diagnoses for breast, lung and prostate cancers at earlier stages, and face lower mortality rates for the four most common cancers.

In the UK, there are approximately 360,000 new cancer cases, and 165,000 deaths due to cancer, reported each year; early cancer detection and diagnosis is essential for improving disease survival rates.

GPs are able to request fast-track, 'urgent suspected cancer referrals' for individuals who present with specified symptoms and are strongly suspected to have cancer; this means individuals can be seen by a cancer specialist or have a specialist test performed within 2 weeks. GPs’ use of such urgent referrals has increased significantly in recent years and the aim of this study was to determine the association between practice use of urgent referrals, cancer stage at diagnosis and patient mortality associated with the most common cancer forms.

For this 5-year national cohort study, researchers analyzed data from Public Health England’s National Cancer Registration and Analysis Service on more than 1.4 million individuals who were diagnosed with breast, lung, prostrate or colorectal cancers from 2011–2015.

Investigators observed that individuals belonging to GP practices with the highest rates of urgent referrals had lower mortality risks across all cancers studied – the mean hazard ratio for individuals belonging to high-referring practices compared with low-referring practices was 0.96.

Similarly, these individuals were more likely to receive earlier-stage cancer diagnoses for breast, lung or prostate cancer compared with individuals seen at practices with low urgent referral rates, though not for colorectal cancer.

Contributing study author Thomas Round (King’s College London) stated: “This research shows that GPs are referring substantially more patients with suspected cancer, which is making a real impact in improving cancer outcomes in the NHS.”

In the study, the authors concluded: “Higher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer.”

Various reports have suggested that amidst the COVID-19 pandemic, individuals may be delaying seeking medical help because they think their GP practices or A&E departments are closed, however, Round commented: “This is not the case, with GP practices adapting with use of telephone, video and online appointments. It is important if patients are experiencing worrying symptoms to contact their GP practice. Whilst the assessments may be different, and NHS capacity is stretched, we are still trying to facilitate urgent 2 week wait referrals in collaboration with our hospital colleagues.”

“With approximately 450 cancer deaths per day in the UK it’s important that we continue urgent referrals, diagnosis and treatment for cancer patients,” Round concluded.


Round T, Gildea C, Ashworth M, Møller H. Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study. Br J Gen Pract. doi:10.3399/bjgp20X709433 (2020) (Epub ahead of print);

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Ilana Landau

Assistant Editor, Future Science Group

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