Cancer referral in younger patients – do age threshold guidelines need updating?

Start Date Sep 2020

Code L8-C

Status Ongoing

Project Lead
Senior Lead
Dr Stephen Bradley, Dr Bethany Shinkins, Lesley Smith, Dr Stephanie Honey, Pete Wheatstone (all Leeds), Dr Cristina Renzi (UCL), Dr Suzanne Scott (King’s College London)    

GPs often take a patient’s age and perceived likelihood of cancer into account when deciding whether they need an urgent referral for cancer tests or not.

For example, current guidelines state that patients with unexplained rectal bleeding should be offered an urgent referral if they are above 50, whilst referral of younger patients should be considered only if rectal bleeding is accompanied by other symptoms. This is because the risk of cancer increases with age, so some symptoms are less likely to be cancer if the patient is young. As a result, younger cancer patients are more likely than older ones to visit their GPs at least three times before being referred.

There is evidence that some cancers are becoming more frequent in the younger, possibly due to risk factors, such as obesity, being more common today than in the past. The increased number of people getting colorectal cancer before the age of 50 is particularly well documented  but other cancers (for example kidney, pancreatic, gastric and endometrial cancer) (2, 4-6) have also been shown to affect more younger people in recent years than in the past. If cancer is becoming more common in the younger, but there are age limits to decide who to refer and whether to refer through the urgent or non-urgent pathway, an increasing number of patients may face a delay in diagnosis during which their cancer could progress to a less curable stage.

There is little information on whether GPs strictly adhere to these age guidelines or take other factors into consideration when deciding about the referral of a younger patient (for example co-morbidity, deprivation, multiple consultations for the same symptom or their own ‘gut feeling’).

In this study we will: 1. Review the evidence suggesting that more people are diagnosed with cancer at a younger age; 2 Examine the evidence behind age thresholds for the investigation of some cancers; 3. Explore whether age has a strong impact on GP’s referral decisions.

Our aim is to determine whether clinical guidelines need updating, for which cancer(s) this would be most relevant, and for what categories of younger patients.

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