Study finds higher cancer rate in patients given ‘all clear’

An intriguing UK study has found that people who get urgent referrals for suspected cancer, but were found not to have cancer after all, had a higher-than-expected risk over the next five years.

Researchers from Queen Mary University of London, the University of Oxford and the National Disease Registration Service run by NHS England say the study is the first to examine the rate of cancer in this group of patients, and suggests they could benefit from additional support to help them manage the risks.

NHS England operates urgent referral pathways for people with suspected cancer in an attempt to speed up assessment by a specialist and start any required treatment as early as possible. Almost three million people went down this route in 2022-23, according to a paper on the study published in The Lancet Oncology, and around 7% of them were found to have cancer.

The team looked at cancer rates in patients not diagnosed with cancer after an urgent referral, and found 63,112 cases of cancer in this group over the next five years, which is equivalent to a rate of 4.5%. That proportion is not considered high but is higher than people of similar age and gender in the general population, they suggest.

While an obvious explanation for the disparity could be cancers that are being missed in the referral, that isn’t the case, according to the researchers, led by Suzanne Scott, professor of health psychology and early cancer diagnosis at Queen Mary.

Rather, the subsequent cancers are likely caused by risk factors – such as poor diet, smoking, or alcohol consumption – which could be addressed by providing additional support to patients.

“In this study, we found that having cancer ruled out doesn’t lessen the future risk of cancer,” said Prof Scott.

“This means patients and GPs should remain vigilant when experiencing new or ongoing symptoms,” she added. “The timing of urgent suspected cancer referrals could be an opportunity to raise cancer awareness, and consider ways to reduce the risk of cancer and other serious diseases, by making a positive change in health behaviour.”

The increased risk of any subsequent cancer was lowest following suspected gastrointestinal cancer referrals, and highest after suspected urological or lung cancer referrals, according to the data. For risks of the same cancer, as was suspected at initial referral, the highest were for the head and neck and lung pathways.

“One of the possible reasons for the pattern found in this research is that people who are urgently referred could have a higher risk of developing cancer in general,” remarked Naser Turabi, director of evidence and implementation at Cancer Research UK, which provided funding for the study.

While more research will be needed to confirm that hypothesis, Turabi emphasised the importance of patients contacting their GP is they notice anything out of the ordinary.

“Even if you’ve been checked out in the past, if something is new, isn’t going away, or is getting worse, go back to your GP,” he said.