Incidence of ‘Low-Risk but Not No-Risk’ Features of Cancer Prior to High-Risk Feature Occurrence: An Observational Cohort Study in Primary Care

SIMPLE SUMMARY: The earlier we can find cancers, the better the chance of survival. Currently, when a patient visits their General Practitioner (GP) with a symptom that might be cancer, they are referred to the hospital for urgent further testing if the symptom is a high risk for cancer. This study aims to find out whether patients who see their GP with a high-risk symptom have also seen their GP with a ‘low-risk but not no-risk’ symptom in the previous year. If this is the case, lowering the referral threshold might allow them to be identified earlier, resulting in improved outcomes if diagnosed with cancer. ABSTRACT: Diagnosing cancer may be expedited by decreasing referral risk threshold. Clinical Practice Research Datalink participants (≥40 years) had a positive predictive value (PPV) ≥3% feature for breast, lung, colorectal, oesophagogastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial or laryngeal cancer in 2016. The numbers of participants with features representing a 1–1.99% or 2–2.99% PPV for same cancer in the previous year were reported, alongside the time difference between meeting the ≥3% criteria and the lower threshold criteria. A total of 8616 participants had a PPV ≥3% feature, of whom 365 (4.2%) and 1147 (13.3%), respectively, met 2–2.99% and 1–1.99% criteria in the preceding year. The median time difference was 131 days (Interquartile Range (IQR) 27 to 256) for the 2–2.99% band and 179 days (IQR 58 to 289) for the 1–1.99% band. Results were heterogeneous across cancer sites. For some cancers, participants may progress from presenting lower- to higher-risk features before meeting urgent referral criteria; however, this was not usually the case. The details of specific features across multiple cancer sites will allow for a tailored approach to future reductions in referral thresholds, potentially improving the efficiency of urgent cancer referrals for the benefit both of individuals and the National Health Service (NHS).