Abstract Body

Most patients with cancer present to primary care - even when there are strong cancer screening programmes. A large programme of research in the early 2000s identified - and quantified - the symptoms of cancer when presented to primary care. This was crucial, as almost all previous research had been reported from the secondary care, selected population. Thus we now know for all the major cancers what the main symptoms are - and what the risk is of there being a cancer when they report a symptom to primary care.

This knowledge allowed planning of services - in particular how many patients would be expected to need a referral, a chest X-ray, a colonoscopy, etc. It also allowed guidance to be prepared for GPs to help them select who should be investigated rapidly for possible cancer. In the UK, this led to the NICE guidance, NG12, in 2015.

Since the publication of NG12, and up until the COVID-19 pandemic, several markers of improved cancer diagnosis all showed improvements. The number of referrals for urgent investigation rose by about 10% each year, the time to diagnosis of symptoms newly introduced in NG12 fell, the stage of the cancer at diagnosis improved, and there was a fall in the percentage of patients being diagnosed after an emergency presentation. 5-year survival also continues to improve. Much of this improvement ceased with the pandemic.

In recent years further changes have been: a large RCT of electronic tools to identify patients with possible cancer in GP records, an estimate of the resource requirements needed should the UK move from a 3% risk of cancer being the threshold to trigger urgent investigation down to 2%, or even 1%. Finally, the health-economics of symptomatic diagnosis are beginning to be unravelled, as we become better at estimating the benefits of expedited diagnosis.