Three times variation in number of patients GPs send for cancer tests

Thousands of cancer patients may be treated too late because some GPs are three times less likely to refer them to a specialist, official figures have revealed for the first time.Three times variation in number of patients GPs send for cancer testsSome family doctors are referring three times more patients with cancer symptoms to specialists than others, raising fears that large numbers of people are missing out on an early diagnosis which can affect their chances of survival.

The official figures mean that for the first time patients can compare the referral rates for suspected cancer at their own GP practice with others nearby and with the local and national averages.

Experts said the wide variation in referral rates was ‘worrying’ because those GPs sending relatively few patients to hospital for tests may be missing cases while others sending large numbers of patients may be causing unnecessary anxiety.

The figures from the National Cancer Intelligence Network (NCIN) found 1,000 GP practices referred more than 2,550 people per 100,000 and a similar number sent fewer than 830 patients per 100,000 for tests.

The correct number of referrals is yet to be established but it is thought those at either end of the spectrum are likely to be due to variation in standards of care.

In most cases the primary care trust areas with the highest referral rates match the areas which are known to have high prevenance of cancer such as the north west and south west.

The individual GP practice with the highest referral rate was 5,591 per 100,000 at Netherton primary care trust practice in Sefton and the lowest referral rate recorded was Dr C B Patel in Hillingdon, London with 89 per 100,000.

The figures also reveal the proportion of patients who were referred to specialists who went on to be diagnosed with cancer.

The so-called conversion rate showed that on average across England almost 11 per cent of patients suspected by their GP of having cancer and referred urgently, did in fact have the disease.

However the conversion rate also varied widely, again suggesting that some GPs are missing cases of cancer while others are overly cautious.

The highest value rate by primary care trust area is 15.6 per cent in Herefordshire compared with 2.3 per cent in Hammersmith and Fulham which has the lowest conversion rate.

Sarah Woolnough, executive director of policy and information at Cancer Research UK, said: “It’s very worrying to see a more than threefold variation in the rate of urgent cancer referrals among GPs.

“And although the number of people GPs suspect have cancer and send for further tests will naturally vary depending on the age and demographic of their patients this level of variation suggests differing approaches by some GPs.  We urgently need to learn more about what’s behind these differences and tackle any poor practice.”

“We already know that some patients present several times with cancer symptoms before being referred for further investigation, which can lead to late diagnosis. And a delayed cancer diagnosis could prove critical for a patient’s chance of survival.”

It has been calculated that if cancer survival rates matched the European average, 5,000 lives could be saved per year with earlier diagnosis and better treatment. If England’s survival rates matched the best in Europe then 10,000 lives a year could be saved.

The average GP will only see seven patients who have cancer each year. These break down as one case each of breast, bowel, prostate and lung cancers, plus three cancers of other types.


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