Introduction The two week-wait pathway for suspected colorectal cancer (CRC2ww) ensures prompt review and investigation of patients with symptoms concerning for malignancy. Previous investigation of such patients does not preclude future repeat referral yet may not represent efficient use of limited clinic time or diagnostic services. This study aims to evaluate the incidence and outcome of repeat CRC2ww referrals.
Methods A retrospective review of all CRC2ww referrals to our unit over a 4-year period was conducted. Patients with previous CRC2ww referrals were identified from a hospital database. Referral indication and outcome for all referrals was collected.
Results 2731 CRC2ww referrals were made between July 2007 and July 2011, median age 72 (19–102), 1179 (43%) male. 273 cancers were identified including 212 colorectal cancers. 121 referrals were repeat referrals, with 77 made prior to July 2007, and a median 1087.5 (35–2709) days between initial and repeat referrals. Referral indication was the same in 55 (47%) cases. When compared to unique referrals, repeat referral were associated with increased age (79 years vs 71 years, p<0.0001) and increased proportion of females (69% vs 56%, p=0.0048). Six cancers, including two CRC, were identified following repeat referral with a median 1511.5 (477–1988) days between initial and repeat referrals. There was no statistical difference in cancer detection between unique or repeat referrals (5.2% vs 10.4%, p=0.07).
Conclusion Repeat referrals comprise a small proportion of all CRC2ww referrals. Such patients are older and more commonly female. However, cancer detection is not significantly lower in this cohort when compared to those not previously referred. Historical referral or investigation should not preclude future CRC2ww referrals and such patients should be investigated to the same extent as unique referrals.
Competing interests None declared.