Wait Pathway Research Articles

Appropriateness of two-week wait head and neck cancer referrals to a district general hospital.

Objectives The NHS advise urgent referral of patients with suspected head and neck cancers to secondary care to be seen via a two-week wait pathway. The objective of this review was to analyse the two-week wait head and neck cancer referrals to a district general hospital and to identify the prevalence of oral cancer.Materials and methods Patients referred via an urgent two-week wait cancer pathway during the period of 12 October 2020 to 19 January 2022 were identified. Data were extracted and analysed for referral source, patient sex, whether or not a biopsy was undertaken, and the number of patients with a final positive cancer diagnosis.Results Overall, 883 two-week wait referrals were received. Most referrals came from general medical practitioners (50%) followed by general dental practitioners (37%). A total of 379 patients (46%) underwent a biopsy, special investigations, or internal referral to another speciality. The overall prevalence of cancer was 6.2%. Most referrals received were for commonly occurring benign conditions.Conclusion Despite many two-week wait suspected cancer referrals, only a small percentage of patients go on to be diagnosed with head and neck cancer. These results highlight the number of avoidable referrals, which ultimately impact patient waiting lists and clinician time.

BT12 A comparison of outcomes and cost-effectiveness in a teledermatology vs. a standard face-to-face 2-week wait UK model

Abstract Teledermatology (TD) assessment of lesions referred on the 2-week wait (2WW) pathway reduces the need for in-person review, and thus facilitates increased clinical capacity. Although studies have demonstrated that TD can be cost-effective compared with a standard face-to-face (F2F) model, there is a lack of literature on the cost-effectiveness of TD with medical photography in the UK 2WW skin cancer pathway (Snoswell C, Finnane A, Janda M et al. Cost-effectiveness of store-and-forward teledermatology. JAMA Dermatol 2016; 152:702). In this study, we undertook a retrospective analysis of a store-and-forward TD 2WW pathway supported by medical photography at a UK centre (October–November 2022). As a comparator, we looked at the outcomes of a 2WW F2F clinic that took place 1 year earlier. Primary outcomes included comparing costs associated with both TD and F2F clinics, and outcomes after initial TD vs. F2F review (discharges, surgeries and subsequent F2F reviews). Inclusion criteria for TD were age 18–60 years, < 3 lesions referred and lesions being on culturally nonsensitive body sites. Cost estimates were included for physicians, nurses, healthcare assistants, administration staff and medical photographers. The tariff per 2WW skin cancer referral to the trust is £159.27. In total, 292 patient images were reviewed virtually in this study. Thirty of 68 patients in the F2F group met the same age criteria as those in the TD group (18–60 years), and thus these patients were used as comparators. Each 4-h TD session comprised an assessment of 25 patients vs. 12 patients per F2F session. Discharge rates from the first clinic appointment were higher for F2F clinics than for TD clinics (76.7% vs. 58.6%). Referrals for surgery were similar between the two groups (16.7% for F2F and 17.8% for TD). However, we found there were substantially more follow-ups requested after TD assessment vs. patients reviewed in F2F clinics (23.2% vs. 6.7%). The nonattendance rate for TD was 36 of 328 patients (11.0%) vs. five of 73 (6.8%) for F2F. Per-patient cost of the TD pathway was estimated to be £16.16 vs. £25.68 for a F2F 2WW appointment. Total revenue to the trust per clinical session was estimated to be £3981.75 (TD) vs. £1911.24 (F2F). This represented additional revenue of approximately £1975 for TD. Twenty-nine of 33 TD patients who completed feedback questionnaires reported overall satisfaction with the TD pathway. In this study, outcome rates between TD and F2F groups were similar in terms of planned surgeries. Planned subsequent F2F review rates were higher for TD, and discharge rates were higher for F2F. The revenue to the trust was greater for TD than F2F.

BT02 Use of teledermatology in the 2-week wait pathway: 5 years of positive data

Abstract Our teledermatology service was started in 2018 to facilitate the dermatology department’s move offsite and allow for the continuation of inpatient care digitally without the need for increasing staff levels or cross-site working. Its implementation also allowed for efficient adaptation and use throughout the COVID-19 pandemic and recovery following this period. Alongside these aspects, teledermatology has become integral in the department’s rapid-access 2-week wait (2WW) capacity. The pathway involves patients attending the department and undergoing a nurse-led review with upload of the history alongside macroscopic and dermoscopic photographs to the platform for consultant review and management. The platform conforms to all aspects of the British Association of Dermatologists’ teledermatology guidelines and is hosted on the National Health Service’s Health and Social Care Network. Of almost 4000 2WW referrals assessed by digital teledermatology between 2018 and the present, no referrals have been rejected for poor quality, only 1% required urgent face-to-face review with a consultant, 32% were discharged, 53% were booked in for a minor surgical procedure of which half were suspected to be cancer or precancer and performed urgently, and 14% were booked for routine review due to risk factors such a multiple moles and need for a full skin check. Our consultants can assess 40 patients on the digital platform in a 4-h period, and the overall cost is approximately half of a face-to-face clinic, including admin. Of all 2WW referrals, general practitioner diagnosis has remained quite constant, with 30% of lesions thought to be malignant melanoma (MM), 36% squamous cell carcinoma (SCC) and 3% basal cell carcinoma (BCC); in the remaining 31%, no diagnosis was made. Of those referred for surgery by the dermatology consultants, the clinical diagnosis was BCC in 20%, SCC in 22% and MM or MM in situ in 6%; the remainder was thought to be precancerous, atypical naevi or other. We have continued to demonstrate through audit that the clinicopathological correlation in the digital teledermatology clinic is as good as face-to-face clinics for lesion diagnosis because of the quality of the history and images. Our most recent satisfaction survey in 2022 showed 96% patient satisfaction with the initial teledermatology assessment; of those booked for a procedure, 88% strongly agreed that all concerns were addressed prior to surgery. All patients would recommend the service to friends and family. With nearly 5 years of data and continuous evaluation, we have shown the effectiveness of a well-designed, connected digital system in supporting our service without duplication of effort by clinicians or prolongation of the patient’s journey.

BT20 Straight to biopsy vs. face-to-face consultation for skin lesions referred on a 2-week wait pathway: a review of outcomes

Abstract Teledermatology has become an essential tool in the triage and management of skin cancer referral pathways. The implementation of the process varies between dermatology departments. At a large multihospital trust, a retrospective service evaluation was conducted looking at the outcomes between two dermatology sites within the trust. Both use the same teledermatology platform to review all referrals made via a 2-week wait suspected cancer pathway for skin lesions. The main comparator was that one of the sites employs a straight to biopsy (STB) outcome as a potential pathway for referred lesions. The other site conducts face-to-face (F2F) review of suspicious lesions warranting biopsy first. Data were collected for all referrals made to both sites over a week in July 2021. A total of 506 lesions were referred across the two sites. Following teledermatology review at the site where STB was adopted, 32.2% (n = 96/298) of patients had a STB outcome and 33.9% (n = 101/298) had a F2F outcome. In comparison, 48.6% (n = 101/208) had a F2F outcome at the other site. Where STB was employed, biopsies were carried out for 13 intermediate lesions (actinic keratosis, superficial basal cell carcinoma, Bowen disease) vs. seven following F2F review at the other site. Rates of definitive surgery, for example wide local excision, were comparable between sites: 13.4% (STB) vs. 15.5%. Curettage and cautery was performed exclusively for lesions reviewed at the STB site, whereas at the other site, intermediate lesions were seen F2F and likely discharged following management with cryotherapy, topical treatments or conservative measures. The STB model can be appealing as it eliminates the need for a F2F review for lesions that require histological confirmation for diagnosis and management, saving valuable time and resources. However, the multiple stages involved in processing biopsies are costly and resource intensive when considering that many intermediate lesions can be treated from a clinical diagnosis alone. Biopsies are associated with increased morbidity and risk, unnecessary extra steps in patient care. With the Montgomery ruling, the process of consent must be robust and consider the individual values of each patient. Biopsies in more complex anatomical sites may pose additional difficulty when obtaining valid consent. The STB can have a role in the management of skin lesions and can streamline patient pathways. However, it does not replace good clinical acumen and, to remain cost-effective, needs to be employed in an appropriate manner.

13 - Long term follow up of patients referred to the lung two week wait pathway with haemoptysis and a normal CT: do we miss cancer?

13 - Long term follow up of patients referred to the lung two week wait pathway with haemoptysis and a normal CT: do we miss cancer?

The isolated symptom of unilateral tonsillar enlargement has limited value in adults with a suspected head and neck cancer pathway.

Given the uncertainty regarding the predictive value of unilateral tonsillar enlargement and/or lesion in malignancies, this study aimed to evaluate the efficacy of unilateral tonsillar enlargement and/or lesion referral criterion in the adult suspected head and neck cancer pathway. All two-week wait referrals received in 2018-2019 were reviewed. All patients referred with unilateral tonsillar enlargement and/or lesion were included and analysed for patient demographic data, presenting symptoms, initial clinic outcomes and final diagnoses. A total of 4934 urgent head and neck cancer referrals were analysed, and 1.9 per cent of these had unilateral tonsillar enlargement and/or lesion. Only 10 patients were diagnosed with tonsil cancer. All the positive tonsil cancer cases had at least one additional head and neck red flag symptom. The referral criterion for unilateral tonsillar enlargement and/or lesion may be of limited benefit in an already economically challenged National Health Service. Further multicentre studies should be undertaken to refine conclusions on the value of unilateral tonsillar enlargement and/or lesion alone as a criterion for the head and neck cancer two-week wait pathway.

131. Virtual consultations and the Two Week Wait Pathway. Do patients find it acceptable?

National lockdown and social distancing requirements altered outpatient consultants from face to face to virtual. Our first aim was to determine the method of first assessment of two week waits referrals between 16th of March 2020 to the 16th of July 2020 in a regional head and neck unit. The second aim was to determine the acceptability of non-face-to-face methods with patients on a two week wait pathway.

Institution of a two-week wait brain/CNS ‘cancer exclusion’ imaging pathway

Background: NICE guidelines (NG12) recommend that clinicians should ‘consider an urgent, direct access, MRI scan of the brain (or CT scan if MRI is contraindicated; to be done within 2 weeks) to assess for brain or central nervous system cancer in adults with progressive, sub-acute loss of central neurological function’. It was found at our institution that, due to delays encountered when referring patients to the existing neurology two-week wait (2WW) pathway, only 54% of patients with suspected cancer from primary care were scanned within two weeks.

Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms.

To determine the efficacy of a new 2-week wait pathway that uses the faecal immunochemical test (FIT) in primary care to triage patients with high and low risk symptoms suspicious of colorectal cancer (CRC). This service improvement pilot follows 2017 National Institute for Health and Care Excellence guidance, that recommended using FIT to guide referral of patients with low risk, but not high risk symptoms, which continue to be referrred on the 2-week pathway. Patients with high- and low-risk CRC symptoms were tested with FIT and those with faecal haemoglobin (f-Hb) ≥9.5μg haemoglobin/g faeces (hereafter μg/g) were referred to secondary care. Results were tracked and primary care prompted to refer if timely referral was not made. Between December 2019 and October 2020, 5672 patients presented to primary care with high and/or low risk symptoms warranting investigations. Of these, 622 (11%) patients were referred without a FIT, of whom 36 (5.8%) had CRC. The remaining 5050 patients had a FIT, of which 4187 (83%) were processed to produce a quantitative result. Of these, 1085 patients (25.9%) had an f-Hb ≥9.5μg/g and of those, 982 patients (90.5%) were referred and 56 (5.7%) had CRC. A total of 3102 patients (74.1%) had an f-Hb <9.5μg/g, of which 456 (14.7%) were referred and three (0.7%) had CRC. A total of 97 cancers were diagnosed with a cancer prevalence of 1.7%. A 2-week wait pathway incorporating FIT as a triage tool can be implemented successfully in primary care to identify symptomatic patients at highest risk of CRC.

Endometrial cancer rate in Hormone replacement therapy users with postmenopausal bleeding: Retrospective cohort study.

To establish the endometrial cancer detection rate in women using hormone replacement therapy presenting with postmenopausal bleeding. Retrospective cohort study. Setting and populationRapid access gynaecology clinic at a tertiary hospital. Women aged under 60years referred with postmenopausal bleeding. Retrospective study of referrals received between 1 January 2019 and 31 December 2020 including Hormone replacement therapy (HRT) use and histological diagnosis. Histological diagnosis of endometrial cancer, borderline ovarian tumour or endometrial intraepithelial neoplasia. Chi squared test. 1363 women were included. 214 women were using HRT when they experienced PMB and only one of these had endometrial cancer at histology (cancer detection rate 0.47%). 25 of the 1124 women who were not using HRT were diagnosed with endometrial cancer on histology (cancer detection rate 2.18%). Chi squared statistical analysis confirmed this was statistically significant (p value .0156). The endometrial cancer detection rate in women aged under 60years using HRT with PMB is very low. Referral on a two-week wait pathway for suspected cancer diagnosis induces stress and anxiety for the woman and may lead to more invasive initial investigation even though other diagnoses are far more likely. Women aged under 60years with postmenopausal bleeding that have either commenced HRT or had a change to their preparation within the last 6 months should be seen on a less urgent referral pathway if necessary given the very low probability of endometrial cancer.

TU3.2 Has Covid-19 Pandemic affected the management of patient's with colorectal cancer?

IntroductionPatients on the cancer pathway should be investigated on the 2 weeks wait pathway, but Covid-19 pandemic had universal impact on the Healthcare systems. One of the main worries was the impact on cancer patients due to delayed diagnosis and management. Our study looks at the timeframe of investigations for colorectal cancer during the second wave of the pandemic compared to pre covid time.MethodRetrospective study looking at the waiting time to investigate patients with +ve qFIT test during the second wave of pandemic (from November 2020 till March 2021).ResultsDuring this period 150 patients had +ve qFIT test, the main presenting symptom was Change in bowel habits. 90 patients were investigated with colonoscopy, only 16 (17%) patients had the colonoscopy done within 2 weeks from the qFIT result. 23 patients had colonoscopy 2–3 weeks from the result. 30 patients (33%) had the colonoscopy between 3–4 weeks, and 21 patients had to wait between 1–6 months to have the colonoscopy.Out of the 150 patients, 60 patients were investigated primarily with CT scan or CT colon.ConclusionDuring the covid-19 pandemic, majority of patients in our trust were investigated within one month of +ve qFIT test but yet there was some delay in carrying out the investigations compared to the normal pathway and more patients had CT scans as primary investigations before being referred for colonoscopy.

EP-180 Analysis of two-week wait referrals to a colorectal surgery department for iron deficiency anaemia in a rural DGH

Abstract Iron deficiency anaemia (IDA), defined as low haemoglobin and ferritin levels, affects 2–5% of adults in the developed world. Asymptomatic malignant gastrointestinal pathology must be excluded in all patients. Patients referred on a two-week wait Colorectal pathway with IDA between 4/1/2018–28/2/2021 were recruited (n=566). 92.4% of patients were investigated, only 45.2% had true IDA. Although screening for coeliac disease was a prerequisite in the referral pro forma, 63.2% were referred without. NICE guidance recommends upper and lower gastrointestinal investigations in all patients with confirmed IDA. 61.6% of patients had both investigations performed. 65.1% patients were diagnosed with benign conditions- diverticular disease (37.6%), polyp (31%) and hiatus hernia (28.5%). Age was the strongest predictor for pathology in patients with IDA (p=0.001), not specifically for cancer (p=0.111). 4.4% (n=23) patients were diagnosed with colorectal cancer. Low haemoglobin was significantly correlated with cancer (p=0.002), however only 60.9% had low ferritin. Guidelines suggest that only post-menopausal women should be investigated for IDA unless symptomatic or risk factors. Although only 80% had symptoms; the entire cohort had investigations and only 60% returned a positive test. This study highlighted variability in investigations in addition to lack of adherence by primary care physicians to referral guidelines resulting in avoidable referrals and potentially inappropriate investigations in pre-menopausal women by secondary care physicians, thus overwhelming an exceedingly burdened two- week wait pathway.

TU2.9 Under-investigation of iron deficiency anaemia in QFIT-negative suspected colorectal cancer patients

Abstract Introduction QFIT (Quantitative faecal immunochemical testing) has become the first-line screening tool for suspected colorectal cancer due to a lower risk profile, higher sensitivity and specificity than routine colonoscopy and faecal occult blood testing. Patients with QFIT measurements &amp;lt;10micrograms/ml are considered unlikely to have colorectal cancer and may be discharged from the 2-week wait (2WW) pathway without further investigations, in the absence of other concerning features including iron deficiency anaemia (IDA). We present our findings on the under-investigation of IDA in a cohort of QFIT-negative patients. Method We collected data on 100 patients in a district general hospital, referred via the 2WW suspected colorectal cancer pathway with QFIT measured as &amp;lt;10 micrograms/ml, over a 2-month period. Our data-points included whether iron, ferritin and haemoglobin were measured in the 6months preceding QFIT measurement. Results Our patients included 67 females and 33 males, with a median age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin blood tests; 21 of which did not have their haemoglobin measured either. 25 out of 100 patients underwent iron, ferritin and haemoglobin blood tests in the specified time period. Discussion Failure to investigate IDA in QFIT-negative suspected colorectal cancer patients increases the risk of missed pathology. Studies have found patients with right sided colon cancer sometimes have false negative QFIT results but often present with IDA. We propose that mandatory investigation of IDA is incorporated into existing 2WW suspected colorectal cancer pathways, alongside QFIT measurement, to mitigate this risk.

Management of the Two-Week Wait Pathway for Skin Cancer Patients, before and during the Pandemic: Is Virtual Consultation an Option?

Background: Although telemedicine emerged more than 100 years ago, the recent pandemic underlined the role of remote assessment of different diseases. The diagnoses of cutaneous conditions, especially malignant lesions, have placed significant stress on the fast-track pathway for general practitioners (GPs), dermatologists, and plastic surgeons. The aim of the study was to compare (pre- and during the pandemic) the ability of professionals to face the challenge. Methods: The study was composed of 1943 consecutive patients (mean age 61.9 ± 18.3, 53.8% female) assessed by GPs, face-to-face (988 patients, 50.8%, between October 2019 and March 2020) and by virtual (video/photo) visits (955 patients, 49.2%, between March 2020 and October 2020) for skin lesions, and referred to secondary care via the two-week wait pathway for suspected skin malignancy. Results: The two groups had similar primary skin malignancies identification rates (24.3% vs. 22.1%, p = 0.25). The virtual visits identified squamous cell carcinoma (SCC) better than face-to-face consultations (p = 0.04), but identified basal cell carcinoma less-well (BCC, p = 0.02), whereas malignant melanoma (MM) was equally identified in the two groups (p = 0.13). There was no difference in the median breach time (days) of the two-week wait pathway (12, IQR = 6 vs. 12, IQR = 5, p = 0.16) in the two groups. Virtual assessments (by GPs) of skin lesions suspected of malignancy, and referred via the two-week wait pathway, increased the probability of diagnosing SCC by 42.9% (p = 0.03), while for malignant melanomas, face-to-face and virtual consultations were alike (p = 0.12). Conclusions: The equivalent outcomes in the management of skin cancers (SCC, MM) via the two-week pathway through virtual consultations and face-to-face appointments underline the role of telemedicine as a reliable alternative to face-to-face assessments.

The incidence of cervical cancer in women with postcoital bleeding and abnormal appearance of the cervix referred through the 2-week wait pathway in the United Kingdom: A retrospective cohort study.

To determine the incidence of cervical cancer in women referred through the 2-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix. A retrospective cohort study was conducted of women with postcoital bleeding, or abnormal appearance of the cervix referred to colposcopy clinics through the 2-week-wait pathway for suspected cervical cancer at Cambridge University Hospitals in the United Kingdom over 5 years. Women were identified from a departmental database. Clinical and demographic data were collected. Categorical data was analyzed with chi-squared or Fisher's exact tests and predictive values were calculated. Of the 604 women referred, 1.16% were diagnosed with cervical cancer. None of the women who were up-to-date with cervical screening were diagnosed with cervical cancer, while 6.25% of women out-of-date with cervical screening or outside the screening age group were diagnosed with cervical cancer (p < 0.001). The positive predictive value for diagnosing cervical cancer was 1.70% for postcoital bleeding (95% confidence interval [CI] 0.64-3.7) and 0.31% for abnormal appearance of the cervix (95% CI 0.0008-1.7). The incidence of cervical cancer in women referred through the 2-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix is low. These referrals have considerable implications for both patients and clinicians, and have a low predictive value for diagnosing cervical cancer. In light of emerging evidence and changing practices, referral guidelines should be reviewed based on up-to-date data and current practices.

DS22: The impact of using teledermatology versus face‐to‐face reviews when seeing patients that are referred via the 2‐week wait pathway for suspected cancers, and overcoming some of the barriers in the new COVID era

DS22: The impact of using teledermatology versus face‐to‐face reviews when seeing patients that are referred via the 2‐week wait pathway for suspected cancers, and overcoming some of the barriers in the new <scp>COVID</scp> era

A 2 and 5-Year Longitudinal Analysis of 671 Consecutive Patients Diagnosed with Unilateral Vestibular Schwannoma.

To analyse the 2 and 5-year outcomes of a cohort of patients with newly diagnosed vestibular schwannoma patients. Longitudinal cohort study. Tertiary skull base referral unit. Six hundred and seventy-one consecutive patients referred to the Cambridge Skull Base Unit between 2005 and 2010. 1) Treatment outcomes, 2) hearing preservation, 3) facial nerve function, and 4) gross tumor control. At initial diagnosis, 440/671(65.6%) of patients entered a watch, wait and rescan (WWR) pathway, 208/671 (31%) underwent primary microsurgical excision and 23/671 (3.4%) primary radiotherapy. Of patients who entered WWR, 144/440 (32.7%) exhibited tumor growth necessitating secondary intervention at a mean of 22.7 months; 67.4% had radiotherapy and 32.6% surgery. Radiotherapy was successful at achieving tumor control in 95% of cases. Primary surgery via the translabyrinthine route was performed in the majority of cases allowing for a radiologically clear surgical resection in 93% of cases. The Cambridge philosophy of treating the newly diagnosed vestibular schwannoma aims at preserving functional status where possible. In patients with small tumors it is recommended that they are placed on to a WWR pathway, of which 67.3% will not exhibit any growth by 5 years. If small tumors grow more than 2 mm by serial scanning, radiotherapy offers a high rate of tumor control. In patients with larger tumors more than 20 mm we would advocate microsurgical excision by the translabyrinthine route which offers excellent functional outcomes and gross tumor control.

Risk-stratified FIT for urgent colonoscopy in Lynch syndrome: A clinical service throughout the COVID-19 pandemic.

10606 Background: Lynch syndrome (LS) is an inherited disorder characterized by pathogenic variants within mismatch repair genes resulting in an increased risk of colorectal cancer (CRC). In England, the fecal immunochemical test for Haemoglobin (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. Herein, we report results from a national emergency clinical service implemented during the COVID-19 pandemic which used FIT to prioritize colonoscopy in LS patients while endoscopy services were limited. Methods: Regional genetic and endoscopy services across England were invited to participate. Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 March 2021. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub’s Research Laboratory in Surrey. The Hub sent patients a FIT kit (OC-Sensor™ (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Lab reports with feecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥10µg of Haemoglobin (Hb)/g (µg/g) faeces: triaged for colonoscopy via an urgent two-week wait (2WW) pathway, (2) f-Hb ≤10µg/g: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits. Results: Fifteen centers across England participated in the clinical service from 9th June 2020 to 31st March 2021. An uptake rate of 64% was observed from this cohort (375/588 invites), though 21 cases were removed from analysis due to repeat FITs, insufficient sample, missing clinical data, or FIT completed after colonoscopy. Of the remaining 354 patients analyzed, 269 patients (76%) had a f-Hb of &lt;6µg/g. 6% (n=23) of patients had a f-Hb that was at or between greater than the limit of detection of the assay (≥6µg/g) yet below 10µg/g.18% (n=62) had FIT results of ≥10µg/g and met criteria for urgent colonoscopy triage via the 2WW pathway. Of the 62 urgently triaged patients, 22 had detectable adenomas, 6 had advanced adenomas (AAs), and 4 were diagnosed with CRC (table). Conclusions: The utility of FIT during the pandemic has demonstrated clinical value for LS patients requiring CRC surveillance. Further longitudinal investigation on the efficacy of FIT in people with LS is warranted and will be examined as part of the multi-center prospective research study “FIT for Lynch Syndrome” (ISRCTN15740250) which is presently recruiting patients in the UK. [Table: see text]

Transforming the 2-week wait (2WW) pathway: management of breast pain in primary care

Breast pain has no association with breast cancer yet is a frequent reason for referral from Primary to Secondary Care, often on an urgent (2-week wait) referral. The referral often...

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.