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.
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.
|投稿者||Moore, Sarah F; Price, Sarah J; Chowienczyk, Sarah; Bostock, Jennifer; Hamilton, Willie|
|ジャーナル名||British journal of cancer|
|組織名||University of Exeter Medical School, College of Medicine & Health, St Luke's;Campus, Magdalen Road, Exeter, UK. email@example.com.;Campus, Magdalen Road, Exeter, UK.;Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK.;Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen;Mary University of London, Mile End Rd, Bethnal Green, London, UK.|