Practice Guidelines

Suspected cancer (part 2—adults): reference tables from updated NICE guidance

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3044 (Published 23 June 2015) Cite this as: BMJ 2015;350:h3044

Adult cancers infographic
Click here to see a printable infographic, showing cancer referral pathways by presenting symptom.

This article has a correction. Please see:

  1. William Hamilton, professor of primary care diagnostics1,
  2. Steve Hajioff, director of public health2,
  3. John Graham, director and consultant in clinical oncology3,
  4. Mia Schmidt-Hansen, researcher3
  1. 1University of Exeter, Exeter EX1 2LU, UK
  2. 2London Borough of Hillingdon, Uxbridge UB8 1UW, UK
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
  1. Correspondence to: W Hamilton w.hamilton{at}exeter.ac.uk

The bottom line

  • In possible lung cancer, someone aged 40 or over with haemoptysis is recommended for urgent referral within two weeks for suspected cancer

  • In possible breast cancer, women aged 30 years or over with an unexplained breast lump or aged 50 years or over with nipple changes are recommended for urgent referral within two weeks for suspected cancer

  • In possible colorectal cancer, patients who do not meet criteria for suspected cancer referral should be offered testing for occult blood in faeces

  • Clinicians should trust their clinical experience where there are particular reasons that this guidance does not pertain to the specific presentation of the patient

It is generally believed that early diagnosis of cancer reduces mortality and morbidity. The National Institute for Health and Care Excellence (NICE) has updated its 2005 guidance on the recognition and referral from primary care of people with suspected cancer.1 The full guidance will be available on bmj.com. This summary of the full guidance is in two parts: part 1 on recommendations for children (up to 15 years old) and young adults (16-24 years), and part 2 on those for adults. Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. However, in practice, young people (aged 16-24) may be referred using either an adult or children’s pathway depending on their age and local arrangements.

Key changes in the updated guidance are:

  • Reliance on new evidence derived from primary, rather than secondary, care

  • Explicit use of a threshold risk of cancer to underpin recommendations for urgent investigation—the first cancer guidance to do so.2

This guidance:

  • Assumes that patients will have had a full history, clinical examination, and appropriate initial blood tests

  • Recommends urgent investigation in adults with a …

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