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Future risk of cancer after urgent suspected cancer referral

Code: BC-DTP_2026_66

Title: Future risk of cancer after urgent suspected cancer referral

Primary Supervisor: Yin Zhou

Email: Yin.zhou@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Secondary Supervisor: Suzanne Scott

Email: Suzanne.scott@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Lay Summary:

When patients visit their doctor with symptoms that could be due to cancer, they may be referred to a specialist to have tests via a fast-track pathway. This is an ‘urgent suspected cancer referral’. More than 90% of people referred this way do not have a cancer diagnosed at that time but may be at risk of future cancer. This PhD projects aims to find out who is most at risk of future cancer after urgent suspected cancer referral. This PhD project will use non-identifiable information from GP surgeries, hospitals and the Cancer Registry in England to study people who were referred with suspected cancer but were found not to have cancer at the time. It will investigate how many people go on to develop cancer in the next 1-3 years and which groups of patients are most at risk. To explore inequalities, thy study will look at how future cancer risk and stage of cancer at diagnosis, differs in patients with different characteristics. These include patient factors (e.g. sex, ethnic group, level of deprivation), health-related behaviours (e.g. smoking status, alcohol intake) and medical factors (e.g. symptoms, body mass index, other medical conditions). The findings will identify patients who are most likely to benefit from targeted support to reduce risk of cancer and improve early diagnosis of future cancer after an urgent suspected cancer referral.

Aims:

This PhD offers a timely and policy-relevant research project that aims to identify patients who are most at-risk of future cancer after having a previous USC referral which did not find cancer. The objectives are to quantify cancer risk after USC referral in a contemporary cohort and: 

  1. Examine variations in cancer risk after USC referral by sociodemographic, behavioural and clinical risk factors [see workstream 1]
  2. Determine variations in risk of advanced cancer (Stage III/IV compared with Stages I/II) after USC referral by sociodemographic, behavioural and clinical risk factors [see workstream 1]
  3. Examine healthcare utilisation after USC referral and to explore how a previous ‘negative’ finding affects subsequent clinical management [see workstreams 1 and 2]

References:

  1. NHS England (2025). Routes to Diagnosis https://digital.nhs.uk/ndrs/data/data-outputs/cancer-data-hub/cancer-routes-to-diagnosis   
  1. NHS England (2024). Cancer Waiting Times. https://www.england.nhs.uk/statistics/statisticalworkareas/cancer-waiting-times/ - cwt-statistics-up-to-september-2024
  2. National Institute for Health and Care Excellence. (2015). Suspected cancer: recognition and referral (NG12). https://www.nice.org.uk/guidance/ng12 
  1. Office for Health Improvement and Disparities. (2023) Public health profiles. Cancer services: two-week referrals resulting in a diagnosis of cancer (conversion rate: as % of all TWW referrals). https://fingertips.phe.org.uk/profile/cancerservices/data#page/4/gid/1938133085/pat/159/par/K02000001/ati/15/are/E92000001/iid/91845/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1   
  1. Scott SE, Gildea C, Nicholson BD, Evans REC, Waller J, Smith D, Purushotham A, Round T. (2023). Future cancer risk after urgent suspected cancer referral in England when cancer is not found: a national cohort study. The Lancet Oncology, 24(11), 1242–1251. https://doi.org/10.1016/S1470-2045(23)00435-7
  2. Office for National Statistics UK (2016). Cancer survival by stage at diagnosis for England (experimental statistics): Adults diagnosed 2012, 2013 and 2014 and followed up to 2015. www.ons.gov.uk/conditionsanddiseases/bulletins/cancersurvivalbystageatdiagnosis. 
  1. Crosby D, Bhatia S, Brindle KM, Coussens LM, Dive C, Emberton M, Esener S, Fitzgerald RC, Gambhir SS, Kuhn P, Rebbeck TR, Balasubramanian S. (2022). Early detection of cancer. Science (New York, N.Y.), 375(6586), eaay9040. https://doi.org/10.1126/science.aay9040
  2. Renzi C, Whitaker KL, Wardle J. (2015). Over-reassurance and under support after a ‘false alarm’: a systematic review of the impact on subsequent cancer symptom attribution and help seeking. BMJ Open 5(2): e007002.
  3. Renzi C, Whitaker KL, Winstanley K, Cromme S, Wardle J. (2016). Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients. British Journal of General Practice 66(644), e158–e170. https://doi.org/10.3399/bjgp16X683845
  4. Evans REC, Watson H, Waller J, Nicholson, BD, Round T, Gildea C, Smith D, Scott SE. (2024). Advice after urgent suspected cancer referral when cancer is not found in England: Survey of patients’ preferences and perceived acceptability. Preventive Medicine Reports 43:102781. https://doi.org/10.1016/j.pmedr.2024.102781
  5. Cancer Research UK (2025). Cancer in the UK 2025: Socioeconomic deprivation.
  6. Department of Health and Social Care (2024). Bowel cancer screening annual report 2021 to 2022. https://www.gov.uk/government/publications/bowel-cancer-screening-annual-report-2021-to-2022/bowelcancer-screening-annual-report-2021-to-2022 
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