TY - JOUR T1 - Trends and variation in urgent referrals for suspected cancer 2009/2010–2019/2020 JF - British Journal of General Practice JO - Br J Gen Pract SP - 34 LP - 37 DO - 10.3399/bjgp22X718217 VL - 72 IS - 714 AU - Lesley Smith AU - Nigel Sansom AU - Scott Hemphill AU - Stephen H Bradley AU - Bethany Shinkins AU - Pete Wheatstone AU - Willie Hamilton AU - Richard D Neal Y1 - 2022/01/01 UR - http://bjgp.org/content/72/714/34.abstract N2 - In the UK, the majority of cancers are diagnosed following referral from the GP after presenting with symptoms, signs, or test results associated with undiagnosed cancer.1 In England and Wales, an urgent referral pathway for patients presenting to GPs with ‘red flag’ symptoms was introduced in 2000, whereby all patients should be seen by a specialist within 2 weeks of referral (known as the Two Week Wait [TWW] pathway). These guidelines were updated in 2015 by incorporating more non-specific symptoms and lowering the threshold of risk of cancer from 5% to 3%.2 The TWW pathway is a high-volume referral pathway and the number of referrals has increased substantially over the last decade; in 2019/2020, 2.4 million patients were referred via this pathway.3 In addition to monitoring TWW referral rates, other key outcome indicators are the conversion rate (percentage of TWW referrals resulting in a cancer diagnosis) and the detection rate (percentage of new cancer cases treated resulting from a TWW referral) (Box 1). Improving the detection rate is a key priority as this means that patients may be diagnosed more promptly rather than by other routes such as emergency presentations, which have poorer survival.1 However, obtaining the right balance between high detection rate and low conversion rate is difficult and complex, involving many stakeholders.4 The full impact of increasing referrals on conversion and detection rates, as well as the wider impact on patients and the health system, is not well understood.4 There is a growing body of published data on cancer diagnostics publicly available including data by cancer pathway. Two Week Wait (TWW) referral rate: number of TWW referrals divided by the population multiplied by 100 000.Conversion rate: percentage of TWW referrals that resulted in a diagnosis of cancer (equivalent to the positive … ER -