UCL Health


Assessment of underlying cancer risk

This project is examining way of enhancing the implementation of patient selection (triage) for assessment of underlying cancer risk

Illustration of 3 doctors

20 June 2024


Common diagnostics can help assess underlying cancer risk, but many cancer patients do not receive them as part of their initial assessment. Faecal Immunochemical Testing (FIT) has been implemented at pace, but completion and return of the test, and subsequent referrals vary by sociodemographic group. Blood test abnormalities detected many months pre-diagnosis is seemingly missed or misattributed to other causes.  Test panels are recommended for triaging referrals, but which test abnormalities should trigger referral remains unclear. Further, there is a need to survey concordance with referral guidelines and related variation by patient group and over time. Risk stratification approaches using primary care records data have been developed and some have been externally validated. However, the potential for risk-based approaches to patient selection is not realised as these tools are rarely used. Prediction tools require sophisticated analytics but their implementation in real-time is not supported by available health records software (EMIS, SystemOne, Vision). Medical device regulation requirements further impede clinical translation of prediction tools. 

For patients with low-risk symptoms not justifying immediate urgent referral, immediate specialist referrals cannot be recommended. When cancer is present a vigilant approach post-initial consultation (‘safety-netting’) can shorten diagnostic delays, through appropriate re-consultation or proactive follow-up. Safety-netting consultation tools, and text messages post-consultation (‘text-netting’) can support appropriate re-consultation, or follow-up, but evidence of effectiveness is currently lacking. 

Aims and objectives

  • To identify patient group inequalities in test use for triaging patients for suspected cancer referral and concordance with existing referral guidelines. 
  • To enable risk stratification model development and clinical implementation.  
  • To identify effective diagnostic strategies to prevent premature diagnostic closure. 

Policy Relevance & Dissemination  

We will identify key bottle necks across phases of the testing process (e.g., between test request – test performance – test result – and test response) and degree of guideline concordance to reveal implementation strategies to optimise the primary or secondary care assessment of patients with possible cancer symptoms.

We hope to remove barriers to optimising patient selection for cancer investigation through risk stratification using prediction tools, and identify and develop patient, GP, and system level solutions to optimise diagnostic reasoning and patient follow-up.

This is to prevent delays and late-stage diagnoses in patients with non-alarm symptoms, and will involve direct engagement with DHSC policy teams; NHS England Cancer Teams; Cancer Research UK Policy; CRUK Test Evidence Transition team; RCGP; SAPC; and MHRA. 

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The NIHR Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis is part of the NIHR and hosted by UCL.