Key considerations in suspected cancer referrals

50% of us will develop cancer in our lifetimes, but prompt diagnosis can be challenging, with even red flag symptoms in primary care having a relatively low positive predictive value (PPV) and many cancers presenting with non-specific symptoms such as fatigue or weight loss. GPs have a key role in cancer diagnosis, including assessing symptoms, undertaking appropriate testing and using urgent suspected cancer (USC) referrals as a key route to diagnosis.

This course sits within the curriculum field ‘People with long-term conditions including cancer’. It discusses patients who present with symptoms that may represent cancer and considers key concepts such as the positive and negative predictive value of symptoms and tests, and how such values might change when different populations of patients are considered, depending on the background prevalence of cancer. It covers the change in suspected cancer referral targets in England, with the move away from an appointment within the first two weeks, to a target of cancer having been diagnosed or excluded within 28 days, and looks at how cancer targets are met, or not met, in all four nations of the UK. Jess’s Rule is also discussed, and the importance of thinking again if a patient has been seen several times and no progress has been made towards a diagnosis. Finally, the course thinks about the wider system in which GPs work and the system factors which can contribute to cancer being diagnosed at a later stage than we would like. 

Supported by University of Birmingham with funding from an NIHR grant (NIHR158242). Editorial and content decisions were made solely by the RCGP.