Experts claim late cancer referral 'unlikely to be fault of GPs'

In collaboration with the Press Association

It is unlikely that substandard work by doctors is to blame for late referral rates of suspected cancer patients, according to experts writing in The BMJ.

"We know that some cancers are more challenging to diagnose than others." - Jodie Moffat Cancer Research UK

Dr Georgios Lyratzopoulos from the University of Cambridge, lead author of the analysis, argued that limits in scientific understanding of the disease, as well as how the NHS is organised could play a key role in delaying diagnosis.

The analysis comes following Government plans to rank GP practices by referral time.

According to the experts, eight in 10 people who are diagnosed with cancer are sent to a specialist within one or two visits with their GP after they start experiencing symptoms. And only a minority see them three or more times before a conclusion is reached.

Jodie Moffat, head of early diagnosis at Cancer Research UK, acknowledged the importance of a speedy diagnosis.

“Diagnosing cancer earlier is crucial to give patients the best chance of survival,” she said.

Seeing a GP several times before being sent to a specialist can affect a patient's care and how successful their treatment is by prolonging the diagnosis.

But Lyratzopoulos and his colleagues note that the number of GP appointments is largely a reflection of the difficulty in diagnosing certain cancers.

Patients with clear symptoms, such as a lump in the breast, have fewer appointments than those with less characteristic symptoms, such as internal pain, they explain.

“We know that some cancers are more challenging to diagnose than others. It’s vital that GPs have the right information and support to know which patients need to be investigated and are able to refer patients promptly for tests,” said Moffat.

To speed up progress in this area, Mofatt said, Cancer Research UK is working as part of an NHS England-led programme of accelerated, coordinated and evaluated work on early diagnosis (ACE).

“ACE will help us to understand how the NHS, from GPs to hospitals, can give patients the best possible chances of being diagnosed and treated early,” she added.

Lyratzopoulos also proposed that specialist and GPs should work more closely, and advocated for the development of new diagnostic tests for cancers that are tricky to diagnose, but acknowledge that such tests will require careful testing and evaluation.


Lyratzopoulos G., J. Wardle & G. Rubin (2014). Rethinking diagnostic delay in cancer: how difficult is the diagnosis?, BMJ, 349(dec09 3) g7400-g7400. DOI: