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Cancer diagnoses occurring outside referral guidelines

Many patients referred urgently by GPs as suspected cancer cases outside the terms of referral guidelines go on to have a cancer diagnosis, new research reveals.

The authors warned the results suggested cancer cases could be missed if GPs were expected to stick too rigidly to national guidelines. A review of nearly 19,000 urgent referrals by GPs in 516 Scottish practices found wide variation in rates of cancer referral and subsequent detection – much unexplained.

The study, published in November's British Journal of General Practice, found after excluding practices with the highest and lowest 10% of referral rates, variation remained at six-fold. There was no association between the proportion of urgent referrals and published cancer rates for the most common cancers.

Self-reported compliance with cancer referral guidelines was 9.9% and 18.1% of those cases were diagnosed with cancer. However, 7.7% of referrals – 56 out of 734 – considered outside the guidelines also had an eventual diagnosis of cancer.

Study leader Dr Paul Baughan, a GP in Dollar, Clackmannanshire, and chair of the Scottish Primary Care Cancer Group, said: ‘GPs should be able to refer urgently even if it doesn't quite fit guidelines. The 7.7% indicates that guidelines are useful, GPs have the skills to pick up subtle signs they don't cover.'

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