Response to study on cancer suspicion in general practice, urgent referral and time to diagnosis – Judith Brodie, Interim Chief Executive, Beating Bowel Cancer

Posted on - 20/09/2017
Author: Communications Team

A study published today (September 20, 2017) in the British Journal of General Practice looks at the reasons why patients presenting to GPs with possible symptoms of colorectal (bowel) cancer are not systematically referred for investigation.

Bowel cancer mortality rates across the four nations of the UK are below the European average[1]. Yet the study found some GPs who were reluctant to refer patients who met urgent referral criteria. The reasons were various, including poor knowledge of urgent referral criteria, lack of suspicion of common symptoms, financial pressure to reduce referrals and a desire to avoid scaring patients.


Commenting on the study, Judith Brodie, interim chief executive at Beating Bowel Cancer, said: “It is worrying that, despite bowel cancer’s status as the UK’s second biggest cancer killer, some GPs appear reluctant to refer patients presenting with recognised symptoms of the disease and more so that some GPs interviewed appeared to be unaware of symptoms that constitute urgent referral criteria.


“Delayed diagnosis and treatment of bowel cancer has a catastrophic effect on survival rates, with a 97% probability of successful curative treatment for patients diagnosed at stage 1. A stage 4 diagnosis reduces that probability to just 7%, underlining just how important it is to identify and investigate potential symptoms of bowel cancer promptly.


“While the study only covered a very small sample of GPs[2], the finding that some are reluctant to refer on grounds of cost is a rather depressing reflection of the financial pressures on the NHS and the status of bowel cancer in the UK. It’s true that the symptoms can be more complex and less clear cut than for some of the other common cancers but that does not mean that possible patients are any less entitled to referral. Nor should the well-documented shortfall in endoscopy capacity influence referral decisions: there are established NICE referral pathways which represent best practice and which should be adhered to.  Bowel cancer is a very treatable disease, and we simply must do more to detect, diagnose and treat it earlier.  This will save lives, and is why we have been campaigning this year for bowel cancer screening to start at the age of 50 rather than 60 across the UK (it is already 50 in Scotland).


“Indeed, delaying diagnosis is a false economy, with the cost of treating a patient at stage 1 roughly a quarter of that for stage 4. It is also at odds with NHS England’s Cancer Strategy, which includes earlier diagnosis as one of six key measures aimed at saving 30,000 lives a year by 2020.


“The study was conducted prior to the introduction of new guidelines from NICE[3] recommending quantitative faecal immunochemical tests (FIT) for adoption in primary care to guide referral for suspected colorectal cancer in people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway referral. Beating Bowel Cancer wholeheartedly welcomes this recommendation, which offers GPs a clear alternative to endoscopy as a first line of investigation and should help them to identify those patients who need further investigation.


“GPs work very hard and do a fantastic job in the face of substantial pressures and demands.  We are clear that detecting and diagnosing bowel cancer earlier is better for patients and their families, and better for the NHS.”


Bowel cancer is the UK’s fourth most common cancer and the second biggest killer, claiming a life every 30 minutes. Around 110 people are diagnosed with bowel cancer every day – that’s one every fifteen minutes.


[1], Bowel cancer survival in the UK compared to Europe, last reviewed February 6, 2017; accessed September 20, 2017
[2] The study methodology consisted of a semi-structured interview with 18 GPs and 12 practice managers; figures published by NHS Digital in May 2017 show that the total number of full-time equivalent GPs practising in England was 34,372
[3] Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care, published July 20, 2017; accessed September 20, 2017