Reimagining the diagnostic pathway for gastrointestinal cancer


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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Figure 1: The structure of the Danish three-legged diagnostic strategy.
Figure 2: A reimagined, integrated pathway for diagnosis of gastrointestinal cancer.


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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; is a member of the CanTest external stakeholder group. J.E. is funded by an Australian National Health and Medical Research Council Practitioner Fellowship.

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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.

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Correspondence to Greg Rubin.

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The authors declare no competing financial interests.

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Rubin, G., Walter, F., Emery, J. et al. Reimagining the diagnostic pathway for gastrointestinal cancer. Nat Rev Gastroenterol Hepatol 15, 181–188 (2018).

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