Patients with “red flag” cancer symptoms are not being referred by their GP for urgent investigation in six out of 10 cases, one study claims. Separate research suggests nearly 12,000 women could be unknowingly living with breast cancer, due to disruptions to the NHS screening programme.
The first study, conducted by the University of Exeter, University College London, and funded by Cancer Research UK, analysed records from nearly 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines.
They found that six out of 10 patients were not referred for cancer investigation within two weeks of the first visit. Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%).
The “alarm” symptoms included blood in urine, a breast lump, problems swallowing, iron-deficiency anaemia, and postmenopausal or rectal bleeding.
The likelihood of a patient being referred within two weeks varied depending on which symptom they showed. The lowest referral rate was for problems swallowing, at just 17%, and the highest was for breast lump, at 68%.
But a lump is not the only symptom of breast cancer and each year, thousands of cases are detected via the NHS screening programme.
In separate analysis, a charity has warned that almost 12,000 women could be living with undiagnosed breast cancer after missing out on screening and not being referred for tests due to the pandemic.
Breast Cancer Now estimates there has been a 50% rise in the number of women in the UK who have not had vital breast screening since services restarted last summer.
Overall, the charity estimates that almost 1.5 million fewer women had breast screening between March 2020 and May 2021 when compared with pre-pandemic levels.
Disruption to NHS services has been caused by a variety of factors, including screening being paused at the height of the pandemic and fewer women being referred to specialists with possible symptoms of the disease.
This combination means that almost 12,000 people could be living with breast cancer without knowing it.
The warning comes as the Royal College of Radiologists joined Breast Cancer Now in saying breast imaging and treatment services were “massively under-resourced even before the pandemic hit”. It said breast screening teams are now trying to fit two years’ worth of appointments into one year.
“Women with breast cancer are continuing to pay the price due to the impact of the pandemic and, in the worst cases, delayed diagnoses could mean that some women die of this devastating disease,” Baroness Delyth Morgan, chief executive of Breast Cancer Now, said.
“Quickly finding and treating those with undiagnosed breast cancer must be a priority, and governments across the UK must urgently ensure there is sufficient investment to do this – these women do not have time to wait.”
Dr Bianca Wiering, lead author of the Exeter study, added: “Our research found that a number of patients go on to develop cancer after they were not referred for red flag symptoms. This could mean an opportunity to diagnose the cancer earlier was missed. We think this could be improved by stricter adherence to the guidelines and increased awareness of the groups of patients in whom symptoms are frequently missed, including younger patients.
“It’s important to note that this issue does not just lie with GPs – we also need to ensure the services to provide the tests needed on referral are well resourced, which we know is currently not always the case.”