Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership

Charlotte Lynch, Samantha Harrison, Jon D Emery, Cathy Clelland, Laurence Dorman, Claire Collins, May-Lill Johansen, Ross Lawrenson, Alun Surgey, David Weller, Dorte Ejg Jarbøl, Kirubakaran Balasubramaniam, Brian D Nicholson

Research output: Contribution to journalJournal articleResearchpeer-review

4 Downloads (Pure)


BACKGROUND: International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries.

AIM: To explore the variation in primary care referral pathways for the management of suspected cancer across different countries.

DESIGN AND SETTING: Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries.

METHOD: Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care.

RESULTS: Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations, and use of emergency routes.

CONCLUSION: Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice.

Original languageEnglish
JournalThe British journal of general practice : the journal of the Royal College of General Practitioners
Issue number727
Pages (from-to)e88-e94
Publication statusPublished - Feb 2023

Bibliographical note

© The Authors.


  • referral
  • diagnosis
  • primary care
  • cancer
  • Neoplasms/diagnosis
  • Early Detection of Cancer
  • Humans
  • Benchmarking
  • Primary Health Care
  • Referral and Consultation


Dive into the research topics of 'Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership'. Together they form a unique fingerprint.

Cite this