TY - JOUR T1 - New NICE guidance on diagnosing cancer in general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 446 LP - 447 DO - 10.3399/bjgp15X686401 VL - 65 IS - 638 AU - Jon Emery AU - Peter Vedsted Y1 - 2015/09/01 UR - http://bjgp.org/content/65/638/446.abstract N2 - In June 2015 the National Institute for Health and Care Excellence (NICE) published its updated guidance on suspected cancer, replacing the previous 2005 guidelines, which had underpinned the ‘2-week wait’ (2WW) referral system in England and Wales.1 These guidelines, heralded as potentially saving 5000 lives per year in England,2 are just one aspect of a wide-ranging set of government policies over the past 15 years aimed at improving cancer outcomes.There are important changes in the new guidance. Perhaps most significant is that they are much better grounded on epidemiological evidence from primary care, rather than the old guidelines that relied predominantly on secondary care data. This new evidence enabled the guideline developers to identify the patterns of symptoms, signs, and simple investigations associated with specific levels of risk of an undiagnosed cancer. As a consequence, the guidelines have established explicit risk thresholds to recommend urgent investigation within 2 weeks. The old guidelines recommended urgent investigation for symptoms associated with a disparate range of cancer risks but few symptoms had a risk of <5%. In the new guidance a risk threshold of 3% was set for adult cancers, and lower risks agreed for children and young adults who potentially have more to gain from early diagnosis. This was a pragmatic decision balancing patient viewpoints, which in a large English study suggested a preferred 1% threshold,3 and the economic and clinical costs of investigating large numbers of people at low risk of cancer. However, it is important to recognise how the underlying evidence could overestimate the actual risk of cancer as GPs may only record symptoms when they suspect them to be significant. In addition, symptoms in general practice present along a continuum: abdominal pain, bowel habits, or … ER -