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. 2021 Nov;125(11):1593-1597.
doi: 10.1038/s41416-021-01541-4. Epub 2021 Sep 16.

The impact of changing risk thresholds on the number of people in England eligible for urgent investigation for possible cancer: an observational cross-sectional study

Sarah F Moore  1 , Sarah J Price  2 , Sarah Chowienczyk  3 , Jennifer Bostock  4 , Willie Hamilton  2
Affiliations

The impact of changing risk thresholds on the number of people in England eligible for urgent investigation for possible cancer: an observational cross-sectional study

Sarah F Moore et al. Br J Cancer. 2021 Nov.

Abstract

Background: Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation.

Methods: Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with features of possible cancer equating to risk thresholds ≥1%, ≥2% or ≥3% for breast, lung, colorectal, oesophago-gastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial and laryngeal cancers.

Results: The mean age of participants was 60 (SD 13) years, with 73,643 males (49%). In 2016, 8576 consultation records contained coded features having a positive predictive value (PPV) of ≥3% for any of the 11 cancers. This equates to a rate of 5682/100,000 patients compared with 4601/100,000 Suspected Cancer NHS referrals for these cancers from April 2016-March 2017. Nine thousands two hundred ninety-one patient-consultation records had coded features equating to a ≥2% PPV, 8% more than met PPV ≥ 3%. Similarly, 19,517 had features with a PPV ≥ 1%, 136% higher than for PPV ≥ 3%.

Conclusions: This study estimated the number of primary-care patients presenting at lower thresholds of cancer risk. The resource implications of liberalising this threshold to 2% are modest and manageable. The details across individual cancer sites should assist planning of English cancer services.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: SFM reports grants from National Institute for Health Research (NIHR) Academic Clinical Fellowship ACF-2015-23-501, during the conduct of the study; SJP reports grants from NIHR Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis. PR-PRU-1217-21601, during the conduct of the study; WH reports grants from University of Exeter, during conduct of the study; remaining authors received no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

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