Referral Cancer Research Articles

The Deborah James effect on bowel cancer awareness and referrals

After being diagnosed with bowel cancer in 2016, Deborah James devoted her life to raising public awareness of the condition, resulting in a positive impact on referrals, especially among young people

3. Spotting the [LDQUO]Red Flags[RDQUO] – Improving GMPs’ Confidence and Knowledge in Identifying Suspected Oral Cancer

Each month, Western Health and Social Care Trust (WHSCT) receives an average of 15 suspected oral cancer referrals from GMPs. These patients attend with heightened levels of anxiety regarding their suspected diagnosis. Many of these referrals turn out to be non-suspicious. A QI project was proposed to evaluate the knowledge of GMPs in the Western Trust and to monitor the quality of referrals of suspected oral cancer.

Patient-captured images in the triage of skin lesions: 'Project Skin Selfie'.

Dermatology services are overwhelmed with 2-week wait (2WW) skin cancer referrals. We outline a triage system using patient-captured images, taken by dermoscopic smartphone attachments.

Cytomorphological Spectrum of Various Liposarcomas: An Experience at a Tertiary Cancer Referral Center, India

Cytomorphological Spectrum of Various Liposarcomas: An Experience at a Tertiary Cancer Referral Center, India

Outpatient secondary care pathways for head and neck cancer referral result in patient delays for cancer treatment.

The majority of head and neck cancer referrals are received through primary care. A proportion of cancer referrals are received through secondary care specialties. Local delivery plan (LDP) targets in Scotland for cancer investigation are set at 31 days for diagnosis and 62 days to start treatment. The aim was to audit referrals made through non-primary care pathways compared with the standard primary care pathways against LDP targets. New head and neck cancer patients between 1 January 2014 and 1 January 2019 were included. Pathway points were recorded between referral to outpatient clinic, time to multidisciplinary team discussion (MDT) and finally MDT to treatment. 1,276 new patient referrals were received over a 5-year period. Of these, 136 (10%) were referred via non-primary care pathways. The mean time for urgent suspicion of cancer (USoC) referrals to start treatment was 77 days (15 days over target) and for outpatient secondary care referrals was 102 days (40 days over target) (p<0.05). When treatment intent was considered, 841/1,131 (75%) of patients referred via primary care were treated curatively compared with 49/99 (49%) (p<0.05) of patients referred through the secondary outpatient pathway. Patients with head and neck cancer referred from other outpatient specialties face delays commencing cancer treatment and are also associated with a greater likelihood of being treated with palliative intent.

S284 Family Matters: Impact of a Dot Phrase on Complete Family History Documentation During Initial Colorectal Cancer Screening Visits

Introduction: Obtaining a complete family history (FH) informs gastrointestinal (GI) cancer screening and referrals for genetic testing, but this is inconsistently done during colorectal cancer (CRC) screening visits. Previously, we improved the rate of complete FHs obtained to 28.4% from 5.2% after implementing education and a FH screening form in clinic. In this study, we assessed the impact of sharing a FH dot phrase on the rate of complete FHs obtained and genetics referrals made during outpatient CRC screening visits. Methods: We shared a dot phrase that prompts obtaining a complete FH to our gastroenterology division on February 9, 2022. A complete FH was defined as addressing history of cancer in first- and second-degree relatives, colon polyps in first-degree relatives, and GI disease. We reviewed outpatient GI CRC screening visits from February 10, 2022 to March 9, 2022, and compared them to a one-month period of pre-intervention visits. Patient characteristics, rates of complete FH and genetic referrals were extracted. Patients with prior colonoscopies or indications for diagnostic colonoscopy were excluded. Rates of complete FH and genetic referrals were compared between the pre- and post-intervention groups with unpaired T-tests. Results: A total of 188 patient visits were included; 93 post-intervention and 81 pre-intervention. The pre-and post-intervention groups were overall similar, but there were more white patients in the post-intervention group (Table). Complete FHs were obtained in 46/93 (49.5%) of post-intervention visits compared to 23/81 (28.4%) of visits in the pre-intervention group (p = 0.004). Genetic referrals were placed in 1/93 (1.1%) of post-intervention visits compared to 3/81 (3.7%) of pre-intervention visits (p=0.270). Conclusion: In our study, the rate of complete FHs obtained increased significantly to 49.5% from 28.4% after introduction of a FH dot phrase . The rate of genetic referrals was unchanged, though a larger sample size may be required to detect any potential difference. Given there were more white patients in the post-intervention group, further observation of complete FH rates in patients based on race is warranted. When upper GI problems were addressed along with CRC screening, FHs were often incomplete, suggesting a target for further intervention. Overall, further efforts are warranted to increase the rate of complete FHs obtained during CRC screening visits. Table 1. - Baseline characteristics and statistical analyses Patient Characteristics Whole CohortN=174 Pre-interventionN= 81 Post-interventionN= 93 p value Average age at screening, standard deviation [years] 51 51 50 Gender, n (%) Male 75 (43%) 33 (41%) 42 (45%) 0.1416 Female 99 (57%) 48 (59%) 51 (55%) 0.6672 Race/Ethnicity, n (%) AA 85 (49%) 44 (54%) 41 (44%) 0.6455 Asian 9 (5%) 3 (3.7%) 6 (6.5%) 0.1585* Hawaiian or Pacific Islander 0 (0%) 0 (0.0%) 0 (0%) - Hispanic 12 (6.9%) 5 (6.2%) 7 (7.5%) 0.4122 Other 8 (4.6%) 5 (6.2%) 3 (3.2%) 0.3173* Unknown 11 (6.3%) 7 (8.6%) 4 (4.3%) 0.2005* White 49 (28%) 17 (21%) 32 (34%) 0.0024 Complete family history 69 (40%) 23 (28.4%) 46 (49.5%) 0.004 Genetic referral 3 (1.7%) 3 (3.7%) 1 (1.1%) 0.2695 *High estimated error, category with value less than 5.

Informal Providers-Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review.

South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.

Primary care triaging of head and neck cancer referrals using the head and neck cancer risk calculator version 2: impact on a tertiary head and neck service.

This study aimed to investigate the use of the head and neck cancer risk calculator version 2 in a primary care setting and to evaluate the impact of the risk calculator on the number of referrals stratified by urgency and cancer yield. Referrals between April 2019 and August 2019, April 2020 and July 2020 (pre-risk calculator) and August 2020 and July 2021 (post-risk calculator) were analysed. Referral urgency, head and neck cancer risk calculator version 2 score, cancer diagnosis, cancer type and further investigations were recorded. The 2023 patient encounters were analysed; there were 1110 (55 per cent) referrals before head and neck cancer risk calculator version 2 use and 913 (45 per cent) after head and neck cancer risk calculator version 2 use. A higher proportion of older (p < 0.001) and male (p < 0.013) patients were seen post-head and neck cancer risk calculator version 2 use. All cancer cases were seen on the urgent suspicion of cancer pathway post-head and neck cancer risk calculator version 2 use; however, a higher proportion of patients were seen as urgent suspicion of cancer (51.1 vs 83.5 per cent; p < 0.001). Overall, the cancer diagnosis rate increased from 2.7 to 4.1 per cent. The head and neck cancer risk calculator version 2 had high sensitivity in cancer diagnosis. More studies are required to optimise the predicted versus actual cancer probability gap.

835 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in Ruling Out Primary Bowel Cancer: A Review of Current Outcomes

Abstract Aim NICE recommends a FIT &amp;lt;10 may not warrant an Urgent Suspected Cancer(USC) Referral. We aim to assess current outcomes at a local level. Secondary aims included whether a high FIT(&amp;gt;100) determines increased cancer risk and whether a moderate FIT(10–100) warrants a USC referral. Method We retrospectively looked at patients who received a FIT between June-December 2020 in North-West Wales. These were divided into 3 groups: negative FIT(&amp;lt;10), moderate FIT(10–100) and high FIT(&amp;gt;100). They were followed-up for a year to determine the result of further investigations such as Endoscopies, CT Colons or CTs. The histology results from polyps/biopsies/specimens from Endoscopy/Surgery were recorded. Results A total of 909 patients received a FIT, 180 excluded due to no result. 557 were negative, 125 moderate and 47 high. 2 of 557(0.36%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 4 of 125(3.2%) in the moderate FIT group and 10 of 47(21.27%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 1(2.13%) in the high, 3(2.4%) in the moderate and 0 in the negative Group. Conclusions Inappropriate investigations and delayed diagnosis can both have drastic clinical and financial implications. Our results show that a negative FIT, with a thorough history and examination, should prevent a need for a USC referral for primary bowel cancer. Patients with high FIT could proceed to investigation, while moderate FIT may need further assessment.

100 Triaging Two Week Wait Referrals According to ABS Guidelines Established During the COVID-19 Pandemic Is Safe Practice

Abstract Aim CoVid-19 has affected healthcare globally, disrupting cancer care. Two weeks wait (2ww) breast cancer referrals were triaged according to Association of Breast Surgery (ABS) guidelines with patients with no red flag symptoms deemed low risk and able to be discharged back to their GP. This study aimed to assess the safety and efficacy of implementing these guidelines. Method A database was established to prospectively collect 2ww breast cancer referrals from the outset of CoVid-19. Two Consultants triaged the referrals and if there was disagreement, a third Consultant arbitrated. Data were recorded for patient age, gender, presenting complaint, assessment, investigations, diagnosis, and outcome and also time from initial referral to discharge letter to the GP. Results 188 patients were referred via the 2ww pathway to St Bartholomew's Hospital from 22/03/2020 to 08/04/2020. 43 (22.9%) were discharged with a median age of 34 (22–83 years) at the time of referral. The mean time from referral receipt to response was 12.1 (0 – 60 days). 15 (34.9%) patients were subsequently re-referred. Mean time from re-referral to one-stop clinic assessment was 9.1 (2 – 22 days), in keeping with NICE two week wait criteria. Of the patients re-referred, all patients underwent imaging in the form of mammogram and/or ultrasound scan. No patients were found to have pre-invasive or invasive disease. Conclusions Triaging patients based on GP referrals is a safe way of streamlining low risk patients. This has the potential to become standard practice worldwide but requires larger multi-centre studies prior to implementation.

719 2WW Prostate Cancer Referrals - Are We Over Investigating Patients with Normal PSA Results?

Abstract Aim Nationally, men are referred by GPs to urologists for suspected prostate cancer using a cancer pathway proforma for an appointment within two weeks. Criteria include a PSA level above the age-specific range, or an abnormal DRE regardless of PSA result. In this study, we look at the number of cancers detected from patients referred with abnormal DREs and a normal PSA. Method In a single major tertiary urological centre, data on patients referred with suspected prostate cancer were retrospectively collected over a 12-month period. Variables focussed on included those referred with a normal PSA, but abnormal DRE, and analysed using descriptive statistics. Results Over a 12-month period, 935 referrals were made by GPs for suspected prostate cancer. Of those, 15.3% (n=143) were referred due to an abnormal DRE but a normal PSA. The median age of our cohort was 73 (38–92, mean 70.15) with a median PIRADS score of 2, and a median PSA density of 0.04 (0.01–0.19, mean 0.05). From our cohort, 6.3% of men (n=9) had malignant histology. From those with malignant histology, 2.1% (n=3) had clinically significant prostate cancer with a mean age of 79. None of the three men were suitable for radical treatment. Only one man with non-clinically significant prostate cancer went on to have radical treatment. Conclusions Significant time and resources are used for those referred with abnormal DREs and normal PSA results, who for the overwhelming majority do not require any treatment. There may be scope to streamline referral criteria to reduce burden on services.

SP9.1.4 Performance and Cost-Effectiveness of a Virtual Consultation Clinic for 2-Week-Wait Colorectal Cancer Referrals – A Response to the Covid-19 Pandemic

Abstract Aims Measure performance and cost effectiveness of a Virtual Consultation (VC) clinic, compared to face-to-face (FF) clinic, for 2-week-wait (2WW) colorectal cancer (CRC) referrals, which did not meet the criteria for nurse-led Telephone Assessment Service. Methods 2WW CRC referrals were triaged by a colorectal surgeon to either a doctor-led VC or FF clinic. Demographics, referral indications, and primary outcome measures (time to clinic/results; investigation type; cancer detection rate) were compared pre-pandemic (November 2019–January 2020) and during the pandemic (May–June 2021). Results 158 (pre-pandemic) and 160 (pandemic) consecutive patients were analysed, with no difference in age (74 vs. 75 years, p=0.936). During the pandemic, patients were referred with an increased number of positive FIT tests (29 vs. 13%, p&amp;lt;0.001), were more likely to have computerised tomography (65 vs. 45%, p=0.003), had a longer time from referral to clinic assessment (10 vs. 8 days, p=0.002), but were informed of results more promptly (59 vs. 138 days, p&amp;lt;0.001) than pre-pandemic patients. During the pandemic patients were assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There were no significant differences in cancer detection rate pre or during the pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during the pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed £15,000 per annum saving with doctor-led VC clinic. Conclusion Virtual consultation for 2WW CRC referrals may improve efficiency without compromising the cancer detection rate, as well as reducing risk of Covid-19 transmission and being more cost effective.

SPOD3 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in ruling out Primary Bowel Cancer: A review of current outcomes.

Abstract Aim NICE recommends that a FIT &amp;lt;10µgHb/g may not warrant an Urgent Suspected Cancer (USC) Referral. Our primary aim was to assess outcomes at a local level for FIT &amp;lt;10µgHb/g. Secondary aims included whether a high FIT(&amp;gt;100µgHb/g) determines increased cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC inv: estigations. Methods A retrospective review of all symptomatic patients who received a FIT in a District General Hospital in North Wales between June-December 2020. These were divided into 3 groups: negative FIT(&amp;lt;10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(&amp;gt;100µgHb/g). The results of any subsequent investigations such as Endoscopies, CT Colons or CTs were recorded along with the histology results from polyps/biopsies/specimens from Endoscopy/Surgery. Simple sensitivity and negative predictive value(NPV) analyses were performed. Results A total of 722 patients returned a FIT result. 544 were negative, 106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62% was demonstrated. Conclusions A negative FIT can adequately exclude primary bowel cancer in symptomatic patients. Patients with high FIT could proceed “straight-to-test”, while moderate FIT may need further outpatient assessment. Inappropriate investigations and delayed diagnosis have drastic clinical and financial implications.

SP9.1.3 Colorectal Cancer Referrals During COVID-19: The Use of CT and qFIT in Triaging Patients in NHS Grampian

Abstract Introduction The COVID-19 outbreak resulted in fundamental changes to clinical practice for patients referred to secondary care with lower gastrointestinal symptoms. The use of colonoscopy services was reduced due to a perceived risk of viral transmission. Resultantly, computed tomography abdomen pelvis (CTAP) scans were utilised to triage patients. This study aimed to assess the accuracy of CTAP and qFIT in triaging patients at risk of colorectal cancer. Methods This study retrospectively gathered data on patients referred via the urgent suspected cancer (USC) pathway from the start of lockdown over a 6-month period in a single Scottish Health Board. Data were collected on presenting symptoms, qFIT levels, vetting decision, investigations, and subsequent diagnosis. Patients were vetted into one of five pathways: CTAP, direct to colonoscopy, downgraded from assessment, flexible sigmoidoscopy, or CT colonography. Results The overall cancer detection rate was 6.4%. Of the patients with cancer on the CTAP pathway, 22.9% had cancer undetected on CTAP which was later identified on colonoscopy. In the cohort of patients with colorectal malignancy, 7.5% had a negative qFIT value (&amp;lt;10 ug/g). Conclusion CTAP alone may not be accurate in detecting colorectal cancers. One should consider the whole clinical picture and decide whether further imaging is warranted following a negative CTAP scan. Additionally, qFIT remains the leading laboratory investigation within screening programmes, however, it should not be used in isolation to rule out colorectal malignancy.

O013 The increasing burden of the two-week wait colorectal cancer pathway within a single centre

IntroductionIncreasing demand has placed colorectal cancer (CRC) two-week wait (TWW) pathways under pressure. The primary aims of this paper are to review TWW referral numbers and CRC diagnoses within our centre over the past 3 years (before, during and in recovery from the COVID-19 pandemic) and compare outcomes to our previously published data (2009–18). This incorporates the introduction of FIT into our clinical practice.MethodsTWW CRC referral data from 1st July 2018–31st July 2021 was analysed. Parameters assessed; monthly TWW referrals, CRC detection, % of TWW referrals seen <14 days and investigations utilised. Data from January 2009 to 31 June 2018 was combined. Unpaired t-test was used to compare group means.ResultsTWW referrals have increased 360% from 2009 to 2020. The proportion of TWW referrals with CRC has decreased from 8.87% to 3.24% over this period, whilst the incidence of CRC remained static (mean 58.7 per annum). From 2009–18, TWW referrals=8921, CRC diagnoses=533, mean monthly CRC detection rate=4.7, ratio of referrals to CRC=16.7:1. From 2018–21, TWW referrals= 6523, CRC diagnoses=232, mean monthly CRC detection rate=6.3, ratio of referrals to CRC=28.4:1. There was a statistically significant difference in mean monthly referrals (p-value<0.00001) between the two periods.ConclusionDespite ever-increasing TWW referral numbers, no significant change in CRC diagnoses has occurred. We find our service under ever-increasing strain. Additional strategies and guidance are required to help address this. Further studies evaluating FIT and repeat FIT in the symptomatic TWW cohort may have a role in generating such a consensus.Take-home messageTwo week wait colorectal cancer referrals have increased 360% in 12 years. Colorectal cancer detection rate remains static over this timeframe.

PA16: Two‐week wait skin cancer referrals to a paediatric dermatology clinic: a service evaluation

PA16: Two‐week wait skin cancer referrals to a paediatric dermatology clinic: a service evaluation

Urgent suspected cancer referrals in a district general hospital: a re-audit of referrals and comparison to NICE guidelines

Urgent suspected cancer referrals in a district general hospital: a re-audit of referrals and comparison to NICE guidelines

A Single-Center Audit of Symptomatic Breast Cancer Patient Referrals During COVID-19 Pandemic Restrictions.

BackgroundRecommendations to balance cancer care with patient and hospital staff safety have been issued to hospitals during the coronavirus disease (COVID-19) pandemic. Concerns have been raised that service restrictions could jeopardize effective cancer management. Thus, this study aimed to conduct an audit to verify this proposition.MethodsWe conducted an audit comparing two-week wait (2ww) breast cancer referrals in our center between May and July 2019 and 2020. The primary endpoints were changes in the overall referral rates, differences in the waiting time, and breast cancer diagnosis rates between the two cohorts. Group differences were evaluated using the chi-square test (χ2). A p-value of <0.05 at 95% CI was considered significant.ResultsThe 2ww referrals decreased by 442 (28.3%) in 2020 (2019 N=1564 vs. 2020, N=1122). Referrals in 2020 were associated with a higher rate of two-week specialist consultation than referrals in 2019 (p<0.05). The 2020 patient cohort was associated with a higher rate of breast cancer diagnosis than the 2019 cohort (6.9% vs. 4.9%, p<0.05). Of the 521 patients who had telephone consultations, 29.2% were discharged, and 367 (70.4%) had post-telephone one-stop clinic visits, of which 9.0% had breast cancer.ConclusionsThe audit provided evidence of effective breast cancer services during the COVID-19 pandemic restrictions. The study results could inform patients and the general public at large that the waiting time and breast cancer diagnosis are not compromised during COVID-19 pandemic management. The high rates of post-telephone one-stop clinic visits and cancer diagnosis may indicate weakness in triage and difficulties in diagnosing nonspecific presentation of cancer over the telephone.

Birth Outcome and Maternal Risk Factors Associated with Childhood Leukemia in Rwanda: A case - Control Study

BackgroundLeukemia is the most common cancer affecting children and remains the top cause of death among children.ObjectiveThis study aimed at determining birth outcomes and maternal risk factors associated with childhood leukemia in Rwanda.MethodsA case control study was conducted at Butaro Cancer Referral hospital. The sample of 103 cases and 103 controls was recruited using the records for children diagnosed with Acute lymphocytic leukemia (ALL) and Acute myelogenous leukemia (AML) and those who were hospitalized for non-cancer treatment as controls. Semi-structured questionnaire and phone calls were used to gather information. SPSS version 21.0 was used to analyze the data. Logistic regression analysis was used to assess the risk factors.ResultsThe majority (56.8%) of children who participated in the study were aged 10-14 years. Overall 41.3% were born via C-Section. It was revealed that children who had had birth asphyxia had about three (3) times increased risk of childhood leukemia [AoR= 2.47, 95%CI: 1.167-5.262, P=0.018] compared to children that had not experienced birth asphyxia. Children who had suffered Neonatal Jaundice, had five (5) times increased risk of getting leukemia [AOR= 5.05, 95%CI: 1.738-14.664, P=0.003].ConclusionIt is important that public and private stakeholders invest more in childhood oncology researches to enable the health system deliver effective management of the cases more efficiently.&#x0D; Rwanda J Med Health Sci 2022;5(2):158-169

Adapting the investigation of patients on urgent suspected cancer pathway with lower gastrointestinal symptoms across Wales during COVID-19.

The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90days following initial referral. A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.