Updated ‘two-week wait’ referral guidelines have not improved colorectal cancer detection rates.


Session type:

Christopher Jones1,Robert Longman1
1Bristol Royal Infirmary



In November 2015, the National Institute for Health and Care Excellence updated its two-week wait (TWW) referral guidelines for suspected colorectal malignancy. This study measured the effect of the change of referral guidelines on (i) the volume of TWW referrals, and (ii) the rate of colorectal cancer detection.


A retrospective review of all colorectal cancer TWW referrals during two periods (July to August 2015 and July to August 2016), to a large inner-city teaching hospital, was undertaken. Cancer detection rates were calculated based on diagnosis obtained from review of patient clinical records and were cross-referenced against the regional cancer registry database.


There was a significant increase in the numbers of patients referred in the period following the change in guidelines (193 vs. 268, p<0.001). There was no significant change in the detection rate of colorectal cancer between the two periods reviewed (8.3% vs. 7.5%, χ2=0.107, p=0.74).


Changes to the TWW referral guidelines have led to an increased number of patients being referred, but have not resulted in a change in the rate of colorectal cancer detection. Further work should focus on establishing if patients are being referred in an appropriate and timely manner, to improve an early cancer detection rate.