OTU-021 Effect of the two-week wait referral pathway on colorectal cancer detection: systematic review and meta-analysis

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In 2000 the two-week-wait (TWW) suspected cancer pathway was launched; national TWW performance data is lacking. This systematic review is the first to comprehensively evaluate the latest evidence on cancer detection through the TWW for suspected lower gastrointestinal malignancy.


This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses [PRISMA] 2009 statement. Cochrane, EMBASE, Medline via Pubmed, NHS Evidence, Trip and the British Library Catalogue were searched, plus references were hand-searched. Disagreements were resolved via consensus. Meta-analysis of pooled cancer conversions rates with 95% confidence intervals were calculated using a random effects model in R studio.


95 full papers and 28 conference abstracts were reviewed. 77.5% full papers reported cancer conversion rate, corresponding weighted mean was calculated with a cancer conversion rate of 7.7% (6.9–8.5 C.I). A forest plot of full-text paper results is shown in figure 1.


The pooled cancer conversion rate via TWW is similar to the cancer detection rate in the asymptomatic Bowel Cancer Screening Population (latest figure 8%) and is not having its intended impact on cancer diagnosis. Re-evaluation of the referral criteria needs consideration, focusing on symptoms with higher PPV in cancer.

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