Diagnosis pathway detects cancer and serious illness in one in five patients

A pathway designed to streamline cancer diagnoses for people whose symptoms fall outside usual guidelines helped detect the disease or other serious conditions in almost one in five patients.

Unexpected health problems were also detected in a similar proportion of patients, according to new study.

The Suspected Cancer (Scan) pathway was created for people with non-specific symptoms, such as unexplained weight loss or fatigue, and gives them rapid access to tests and scans.

The findings from its first six years of use, which have been published in the Lancet Primary Care, provide “vital insights” for those aiming to improve early diagnosis, experts said.

Scan was developed in Oxfordshire in partnership with NHS England, Cancer Research UK and Macmillan Cancer Support and has been standard care across the region since 2020.

For the study, researchers tracked 4,823 patients referred to the Scan pathway between 2017 and 2023.

The analysis found 8.8% of patients were diagnosed with cancer, while 10.9% were given a serious non-cancer diagnosis.

The most common cancers diagnosed using Scan were lung, pancreatic, colon, breast and non-Hodgkin lymphoma.

Elsewhere, Scan revealed unexpected health problems in 19.3% of patients involved in the study.

Researchers referred to these instances as “clinically significant incidental findings”, which means the issue was not the primary reason for the test or scan but requires further attention or treatment.

Dr Claire Friedemann Smith, joint first author and researcher at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said: “Our findings support the value of non-specific symptom pathways like Scan in identifying hard-to-diagnose cancers, but they also highlight the considerable number of incidental findings that can place additional pressure on healthcare systems.

“This study gives vital insights for clinicians, commissioners and policymakers aiming to improve early diagnosis without overwhelming services.”

Researchers said Scan “identified a relatively high proportion of harder to diagnose cancers while identifying a similar proportion of patients with an incidental finding as those diagnosed with cancer and non-cancer disease combined”.

They stressed that further follow-up of the group is needed to assess longer-term outcomes.

Dr Brian D Nicholson, joint first author and researcher at the Nuffield Department of Primary Care Health Sciences, University of Oxford, added: “There is a careful balance to strike when intensively investigating non-specific symptoms between the identification of disease caused by the symptom that requires immediate treatment and incidental findings of unknown significance.

“Using our research database we will now work to identify the additional serious diseases detected during the follow-up of incidental findings to help optimise non-specific symptom pathways in the NHS.”

The study was led by the University of Oxford’s Nuffield Department of Primary Care Health Sciences, Oxford University Hospitals NHS Foundation Trust, the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, and Oxford Cancer.