Intended for healthcare professionals


Diagnosing symptomatic cancer in the NHS

BMJ 2015; 351 doi: (Published 14 October 2015) Cite this as: BMJ 2015;351:h5311
  1. William Hamilton, professor of primary care diagnostics
  1. 1College House, St Luke’s Campus, Exeter EX1 2LU, UK
  1. W.Hamilton{at}

Fast track referral is one part of an improving picture

In a linked article, Møller and colleagues1 present a neat analysis of the use of the fast track referral pathway for patients with suspected cancer in 2009 (two week wait system) by English general practices and subsequent cancer mortality in patients from these practices. In 2009, this fast track pathway enabled access to a specialist opinion or diagnostic test within two weeks for eligible patients. Møller and colleagues studied three measures: the referral ratio (each practice’s use of the two week wait system compared with other practices), detection rate (percentage of cancers in a practice that were detected via the two week clinics), and conversion rate (proportion of patients who went through the two week wait system and who were then shown to have cancer). Practices with a high referral ratio and those with a high detection rate had reduced cancer mortality, although the conversion rate showed no association.

Cancer survival in England has steadily improved since 1995, and this improvement is accelerating.2 Even so, we remain stubbornly behind other European countries, although the gap is narrowing for some cancers.2 This improvement is accompanied by a reduction in emergency presentations for …

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