Has the introduction of the '2 week rule' in the UK led to an earlier diagnosis of urological malignancy?

31 Aug 2011
N Vasdev, AC Thorpe

Introduction: The ‘2 week wait’ target for haematuria assessment has been recommended for early diagnosis of urological cancer. We compare our cancer detection rates pre- and post-introduction of this target and its impact on stage at diagnosis.

Patients and methods: A total of 1,740 patients were enrolled prospectively in the study at our units ‘one stop fast track haematuria clinic’ between April 2003 and March 2006. Evaluation consisted of basic demographics, history and examination, routine blood tests, urinalysis, urine culture and urine cytology. All patients underwent a renal ultrasound, IVU (intravenous urogram) and flexible cystoscopy. The detection rate of urological malignancy was compared to a previous cohort at our institution (April 1994 to March 1997).

Results: A total of 1,067 males and 673 females with a mean age of 60.8 years (range 16–96) were included in the study. The overall cancer detection rate was 18%. With the introduction of the ‘2 week rule’ referrals, we noted a 57% increase in the detection of urological malignancies while comparing previous published data from our institution. There was no statistical significance in stage at presentation following the introduction of the ‘2 week rule’.

Conclusion: Patients with haematuria need to be investigated promptly. The ‘2 week rule’ has increased the cancer detection rate in our institution.

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