QCancer and referral
Early diagnosis of cancer is a real Hot Topic, and there has been a huge ammount of interest on our Autumn courses in using the QCancer tools to aid patient assessment. These tools should obviously only be used to aid
(and not supplant) clinical assessment by a patient’s GP, but the most frequently asked question has been: is there a recommended
referral threshold for the Qcancer risk tool?
So, we asked Prof. Julia Hippisley-Cox herself and this is her reply:
‘In terms of the threshold, there is no absolute
threshold currently – my view is that the tool quantifies risk in a way that
helps the GP and patient make an assessment of probabilities. For some people,
I risk of 2% will seem high and they will want full investigation. For others
they will concentrate on the 98% risk that they don’t have cancer X. The
assessment also needs to take account of the risks associated with
investigation - for lung cancer, then the risk of an adverse event to a
CXR is pretty low but for other tests [eg endoscopic ultrasound scan of the
pancreas] then the discomfort of the procedure and risk of perforation might be
higher.
That said, we have looked at risk thresholds in each of
the papers and there is a table of sensitivity, specificity etc at different
thresholds. I tend to think a threshold of 2% overall is reasonable rule of
thumb (NB this is the referral threshold recommended by the National Cancer Action Team when using the RAT tool for colorectal and lung cancer, Simon). I suspect this is something the new NICE guidelines may address more
fully. I am going to present to them in December.
We have got a new paper coming out [no publication
date yet] which combines all the cancers into one tool and gives a global
cancer risk and then apportions the risk of each cancer. I will let you know
once this is available. In the meantime, there are some slides in the public
section of the download page of www.qresearch.org which will give you an idea.’
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