Introduction The 2WW pathway for direct access upper-GI endoscopy was introduced in 2000 by the Department of Health to encourage early diagnosis of upper-GI cancers. Referrals from Primary Care are influenced by disease and symptom awareness in the general public. Despite widespread education targeted at General Practice, upper-GI cancers are frequently diagnosed late and dyspepsia symptoms are not recognised as serious by the wider public. This study is designed to examine the referral demographics and outcomes in our centre of 2WW referral patients, prior to the introduction of the Be Clear on Cancer National Campaign, and highlight the need of such an education campaign locally.
Method All direct-to-test 2 WW upper-GI cancer referrals at Salford Royal in 2014 were included. Patients were identified from the endoscopy booking system and records accessed from the Electronic Patient Record to identify confirmed cancer diagnoses and subsequent outcomes. Patients who did not attend scheduled endoscopy appointment (n = 6) and patients with previous known upper-GI cancer (n = 1) were excluded from the analysis.
Results 345 patients were included in the study. Significantly more female patients were referred; F:M 195:150 (p < 0.05). The average age by gender was similar, F:M 63.1:61.8 (p = 0.21). Nineteen new cancer diagnoses were confirmed following investigation. Cancer was diagnosed more commonly in men; with a male: female ratio of 3:1. Of the Upper GI cancers (stomach or oesophagus), female patients were more likely to present with curable disease (80% compared to 45% men).
Conclusion Despite both oesophageal and gastric cancer being more common in men than woman (3:1 and 2:1 respectively), men in Salford are much less likely to be referred by Primary Care for 2WW urgent endoscopy. Additionally, female patients are more likely to present with early, and therefore more curable disease.
It is clear from local research that men are less likely to be aware of the symptoms of upper-GI cancer and therefore less likely to seek advice when they have alarm signs. The national Be Clear On Cancer initiative has recently been launched and has already been shown during the pilot scheme to increase endoscopy referral and cancer diagnosis rates.1It is anticipated that the recently launched heartburn awareness campaign will result in more cancer being diagnosed at an earlier (treatable) stage; time will tell if this ambitious target is realised.
Disclosure of interest None Declared.
Data from the National Cancer Waiting Times (CWT) Monitoring Dataset provided by NHS England and accessed via Public Health England’s Knowledge & Intelligence Team (East Midlands Pilot data)
Statistics from Altmetric.com
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