GP referrals through the two-week wait (2WW) cancer diagnosis pathway doubled year on year between 2009/2010 and 2018/2019, resulting in a 68% increase in the number of cancers detected, according to the findings of a new study published in the British Journal of General Practice.
The retrospective cross-sectional study examined the change in use of 2WW referrals in England over 10 years (from 2009/2010 to 2018/2019) and the practice and population factors associated with cancer detection.
Over the 10 years studied, there were 14.89 million 2WW referrals and 2.68 million new cancer registrations, of which 1.26 million were detected via urgent referral. Total 2WW referrals more than doubled to more than 2.24 million in 2018/2019, with an average yearly increase of 10%. However, the yearly conversion rates decreased from 10.8% to 7.3%.
Cancer detection via 2WW referrals increased from 41% in 2009/2010 to 52% in 2018/2019 leading to an increase in cancers diagnosed following 2WW referral from 97,760 in 2009/2010 to 163,932 in 2018/2019.
There were an additional 66,172 cancers detected via 2WW in 2018/2019 compared with 2009/2010—a 68% relative increase. If the cancer detection rate had remained at 41% rather than increasing yearly, approximately 165,899 fewer cancers would have been detected via 2WW over the 10-year period.
Predicted 2WW cancer detection was consistently associated with larger practice list size (positive association) and increasing GP age (negative association), although the association with age narrowed over the study period.
Of concern is that in the last three years of study, cancer detection rates were consistently lower in more deprived areas, an effect not seen in earlier years.
Dr Thomas Round, Lead Author and GP Academic Researcher at King’s College London, said: “This research supports the increases seen in primary care referrals and access to diagnostic tests, which allows more cancers to be diagnosed and improved patient outcomes. This is a positive message that GPs and primary care teams are working hard utilising referral pathways and implementing NICE referral guidelines."
“While we saw a drop in urgent referrals during the height of the pandemic, these have now recovered to pre-pandemic levels. This is a testament to busy GPs and their teams who are delivering over a million appointments every day.”
Dr Round added that the more recent disparity with lower cancer detection in more deprived areas is a cause for concern and reiterates the need for a levelling up agenda and investment in health services particularly in deprived areas.
“In post-pandemic recovery it is crucial to continue to facilitate primary care urgent referrals and support NHS staff delivering these services. This includes significant ongoing investment in primary and secondary care including diagnostic testing capacity to deliver continued improvements to cancer early diagnosis.”
