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Draft NICE urgent referral guidance ‘could delay bladder cancer diagnoses’

Draft NICE guidance on urgent cancer referrals by GPs may delay the detection of bladder and renal cancers, a leading urologist has warned.

The proposals, published last November, introduced an age restriction of 45 years for patients with ‘blood in pee’ to be urgently referred, whereas current guidelines says anyone with blood in urine should be referred urgently via a two-week pathway, irrespective of age.

Although NICE’s new guideline was aimed at increasing the number of early cancer detections – mainly by lowering the approximate threshold from 5% to 3% – Dr Hugh Mostafid, consultant urologist at Hampshire Hospitals NHS Foundation Trust and chair of Action on Bladder Cancer, warned that it could have the opposite effect.

In a blog in the journal Trends in Urology and Men’s Health, Dr Mostafid wrote that proposals could ‘halt, if not reverse’ progress made on early detection for these types of cancer.

He said: ‘[This] sends out the wrong message, namely that people under 45 years old do not get bladder cancer and therefore do not need referring.

‘Would we really not refer a 42-year-old male smoker with frank haematuria?’

In addition, the new recommendations would see patients referred urgently for microscopic haematuria only if they are aged over 60, rather than over 50 as in current guidelines.

Dr Mostafid wrote: ‘Once again, although the incidence of bladder cancer presenting with microscopic haematuria in patients between 50 and 60 years old is low, it sends out the wrong message and may result in these patients not being referred at all.’

NICE centre for clinical practice director Professor Mark Baker said: ‘Late last year NICE consulted on the proposed recommendations for the recognition and management of suspected cancer in children, young people and adults. As a registered stakeholder, Action on Bladder Cancer, along with all relevant patient groups and professional organisations, were encouraged to submit comments via the NICE website during this period. Any comments received will be considered before final recommendations are published later this year.

‘NICE will also shortly publish new guidance on treating bladder cancer to address the wide variation in the treatment options available to people with the disease.’



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