The impact of changing risk thresholds on the number of people in England eligible for urgent investigation for possible cancer: an observational cross-sectional study

Background Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation. Methods Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with fea...

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Bibliographic Details
Published in:British journal of cancer 2021-11, Vol.125 (11), p.1593-1597
Main Authors: Moore, Sarah F., Price, Sarah J., Chowienczyk, Sarah, Bostock, Jennifer, Hamilton, Willie
Format: Article
Language:English
Subjects:
692/308/174
692/700/139
692/700/1538
Biomedical and Life Sciences
Biomedicine
Breast
Breast cancer
Cancer
Cancer Research
Colorectal cancer
Cross-Sectional Studies
Drug Resistance
Endometrium
England
Epidemiology
Female
Humans
Laryngeal cancer
Lung cancer
Male
Middle Aged
Molecular Medicine
Neoplasms - epidemiology
Oncology
Pancreatic cancer
Patients
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Summary:Background Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation. Methods Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with features of possible cancer equating to risk thresholds ≥1%, ≥2% or ≥3% for breast, lung, colorectal, oesophago-gastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial and laryngeal cancers. Results The mean age of participants was 60 (SD 13) years, with 73,643 males (49%). In 2016, 8576 consultation records contained coded features having a positive predictive value (PPV) of ≥3% for any of the 11 cancers. This equates to a rate of 5682/100,000 patients compared with 4601/100,000 Suspected Cancer NHS referrals for these cancers from April 2016–March 2017. Nine thousands two hundred ninety-one patient-consultation records had coded features equating to a ≥2% PPV, 8% more than met PPV ≥ 3%. Similarly, 19,517 had features with a PPV ≥ 1%, 136% higher than for PPV ≥ 3%. Conclusions This study estimated the number of primary-care patients presenting at lower thresholds of cancer risk. The resource implications of liberalising this threshold to 2% are modest and manageable. The details across individual cancer sites should assist planning of English cancer services.
ISSN:0007-0920
1532-1827
DOI:10.1038/s41416-021-01541-4