Opinion | Published:

Reimagining the diagnostic pathway for gastrointestinal cancer

Nature Reviews Gastroenterology & Hepatology volume 15, pages 181188 (2018) | Download Citation


A crisis is looming for the diagnosis of gastrointestinal cancers, one grounded only partly in the steady increase in their overall incidence. Public demand for diagnostic tests to be undertaken early and at lower levels of risk is reflected in early diagnosis being a widely held policy objective for reasons of both clinical outcome and patient experience. In the UK, urgent referrals for suspected lower gastrointestinal cancer have increased by 78% in the past 6 years, with parallel increases in endoscopy and imaging activity. Such growth in demand is unsustainable with current models of care. If gastrointestinal cancer diagnosis is to be affordable, the roles of professionals and their interactions with each other will need to be reframed while retaining public confidence in the process. In this Perspective, we consider how the relationship between medical specialists and generalists could be redefined to make better use of the skills of each while delivering optimal clinical outcomes and a good patient experience.

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This research arises from the CanTest Collaborative (Cancer diagnostic testing in primary care: a paradigm shift for cancer diagnosis), which is funded by Cancer Research UK (award number C8640/23385). G.R., F.W. and J.E. are members of the CanTest Collaborative; N.de.W. is a member of the CanTest external stakeholder group. J.E. is funded by an Australian National Health and Medical Research Council Practitioner Fellowship.

Author information


  1. Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.

    • Greg Rubin
  2. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.

    • Fiona Walter
  3. Centre for Cancer Research and Department of General Practice, University of Melbourne, Victoria Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3010, Australia.

    • Jon Emery
  4. Julius Center for Health Sciences and Primary Care University Medical Center, Utrecht, Netherlands.

    • Niek de Wit


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All authors contributed to the design and drafting of the manuscript, and all authors agreed on the final version as submitted.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Greg Rubin.

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