[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-446176-105":59,"doc-detail-446176-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","is-now-the-time-to-rethink-risk-thresholds-in-cancer-referral-guidelines","Is now the time to rethink risk thresholds in cancer referral guidelines?","","Editorials argue that cancer referral guidelines should reconsider fixed risk thresholds because differences in pathway investigations, sequencing, harms, capacity, and delayed-diagnosis impact can make one-size-fits-all thresholds suboptimal. It discusses how risk estimation methods such as population-based PPV versus individualized risk alter eligible urgent cohorts. Using CA125 and FIT examples, the text highlights that combining clinical variables and cost-effectiveness can improve patient selection and resource use while reducing overburdening and unintended harms.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/is-now-the-time-to-rethink-risk-thresholds-in-cancer-referral-guidelines/446176/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/is-now-the-time-to-rethink-risk-thresholds-in-cancer-referral-guidelines/446176.png","ImageObject",300,407,{"name":92,"@type":93},"Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why do the authors question using fixed risk thresholds across all cancer referral pathways?","Question",{"text":112,"@type":113},"They argue that pathways differ in investigation type, sequencing, costs, potential harms, and capacity, so applying one threshold may be neither optimal for outcomes nor for health economics.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does population-based PPV differ from individualized risk in determining referral eligibility?",{"text":117,"@type":113},"A population-based estimate averages risk across people with very low and very high cancer risk, which can change the size of the eligible urgent cohort compared with individualized estimates.",{"name":119,"@type":110,"acceptedAnswer":120},"What examples are used to show the limitations of current thresholds?",{"text":121,"@type":113},"The text cites CA125 for ovarian cancer and FIT thresholds for colorectal cancer, showing that combining test values with factors like age can substantially change estimated risk.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},446176,1792693870,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},687207412472,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Editorials  \nIs now the time to rethink risk thresholds in cancer referral guidelines?  \nBrian D Nicholson, Garth Funston, Charlotte Williamson, Samantha Leigh Harrison and Gary A Abel  \nBackground  \nAround two thirds of patients with cancer diagnosed in England first present to primary care1 so encouraging timely referral of those with signs and symptoms of possible cancer is crucial to improve patient outcomes.  \nThe approach used to quantify risk can have major implications for the size of an eligible cohort. A populationbased risk estimate (such as PPV) of 3% will lead to more patients being eligible for an urgent cancer pathway compared to an individualised risk estimate of 3%, as the populationbased estimate represents an average risk including some people with a very low, and very high risk of cancer. An  \nCancer referral guidelines play a key role in supporting healthcare professionals to identify individuals with suspected cancer in a timely and consistent manner. Most UK guidelines use risk thresholds to determine which patients warrant urgent suspected cancer investigation or referral. These thresholds are based on the positive predictive value (PPV) of signs and symptoms alone or in combination.  \nThe 2015 update of the National Institute for Health and Care Excellence (NICE) NG12 guideline,2 used in England and Wales, introduced a 3% risk  \nindividualised approach may allow more efficient use of health system resources, and improved outcomes.  \nAdditionally cancer pathways differ in terms of investigation type and sequencing. Applying the same risk threshold across all pathways may not be optimal from either an outcome or health economic perspective. For example, pathways that incorporate relatively cheap investigations (such as FIT, chest x-ray), and come with minimal harms to the patient could justify implementing a lower threshold for referral, and conversely a higher risk  \nthreshold to underpin their  \nrecommendations for urgent suspected  \ncancer referral with a few exceptions (such as children’s and young people’s cancers, and investigations accessed in primary care) . This was a reduction from the previous 5% threshold and was based on clinical consensus balancing diagnosing more cancers in a timely manner against overburdening the health service and potential implications for individuals (for example, unnecessary anxiety) .2 Robust evaluation of the impact of the threshold reduction is lacking, except for some research noting minimal changes to diagnostic intervals.3,4  \nthreshold used for more expensive  \ninvestigations with a higher risk of harm (for example, endoscopy) . Ideally, these tests will be used in sequence with a simple triage test in primary care selecting higher risk patients for a more expensive specialist test (such as FIT triage for colonoscopy) .  \nTailored approaches to risk quantification  \nImproved understanding of primary care tests and the  \ndevelopment of prediction models can enable more tailored risk-based triage. While PPV is helpful  \nChallenges with the current approach  \nOver the last decade, there has been a marked increase in cancer research developing alternative approaches to quantifying the cancer risk in patients attending primary care. This growing evidence base presents an opportunity to refresh and refine our approach to patient selection for further cancer investigation.  \nwhen determining which symptoms warrant urgent cancer referral, it may not be the optimal approach for choosing thresholds for tests or prediction models. For example, the PPV of CA125 for ovarian cancer using the current threshold (≥35 U/mL) is 9%, but the individualised risk in a woman with a CA125 value of 35 U/mL is much lower at 1% .5 Using the test level at which a desired risk threshold is reached, rather than the PPV of an ‘abnormal’ test result, will better identify patients who warrant investigation. Risk also varies by  \nBritish Journal of General Practice, December 2025 EDITORIALS | 5","cbCaigWRxLDasI7t","https://ap.wps.com/l/cbCaigWRxLDasI7t","pdf",72986,"English","# Background\n# Cancer referral guidelines and current thresholds\n## Tailored approaches to risk quantification\n## Challenges with the current approach\n# Evidence-informed thresholds\n# Next steps","[{\"question\":\"Why do the authors question using fixed risk thresholds across all cancer referral pathways?\",\"answer\":\"They argue that pathways differ in investigation type, sequencing, costs, potential harms, and capacity, so applying one threshold may be neither optimal for outcomes nor for health economics.\"},{\"question\":\"How does population-based PPV differ from individualized risk in determining referral eligibility?\",\"answer\":\"A population-based estimate averages risk across people with very low and very high cancer risk, which can change the size of the eligible urgent cohort compared with individualized estimates.\"},{\"question\":\"What examples are used to show the limitations of current thresholds?\",\"answer\":\"The text cites CA125 for ovarian cancer and FIT thresholds for colorectal cancer, showing that combining test values with factors like age can substantially change estimated risk.\"}]","Is now the time to rethink risk thresholds in cancer referral guidelines? | PDF",1790714376]