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GPs fear quality visits will be turned into witch-hunts

New draft NICE guidance on urgent cancer referral proposes key changes to rules for cancers such as breast and skin, in response to widespread criticism of the original Department of Health advice.

But the new guidance has already run into trouble, with leading oncologists claiming their opinions were ignored and GPs condemning the 804-page draft for being unwieldy and overcomplex.

And a study in the British Journal of General Practice (August) suggests existing two-week guidelines have made no difference to referrals for colorectal cancer because of implementation problems.

GPs have welcomed some changes to the guidance, with skin cancer rules now including a detailed weighted checklist to assess suspicious pigmented lesions.

The new guidance also offers advice on assessing breast lumps, suggesting GPs should be alert for 'a fixed hard lump, with or without skin tethering'.

But cancer experts have complained the draft failed to take into account evidence from primary care. Dr Nick Summerton, head of the division of public health and primary care at the University of Hull, said: 'It is disappointing – these guidelines won't be any better than the last ones.'

Key changes to

cancer referrals

lSkin cancer: rapidly expanding tumours (possible squamous cell carcinomas) should be referred urgently.

lSkin cancer: change is key element in diagnosing malignant melanoma. Monitor low-suspicion lesions over up to eight weeks using photographs and a marker scale or ruler.

lBreast cancer: in a patient who presents with unilateral bloody nipple discharge referral should be urgent.

lUpper gastrointestinal cancer: consider urgent referral in patients with persistent vomiting and weight loss in the absence of dyspepsia.

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