2025-09-10 オックスフォード大学
<関連情報>
- https://www.ox.ac.uk/news/2025-09-10-new-study-evaluates-effectiveness-cancer-diagnosis-pathway-patients-non-specific
- https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(25)00019-6/fulltext
非特異的症状で「疑いのあるがん(SCAN)経路」に紹介された患者の特徴、重篤疾患診断、偶発所見:英国における前向きコホート研究 Patient characteristics, serious disease diagnoses, and incidental findings in individuals with non-specific symptoms referred to the Suspected CANcer (SCAN) Pathway: a prospective cohort study in England
Claire Friedemann Smith, DPhil ∙ Julie-Ann Moreland, PGCert ∙ Pradeep S Virdee, PhD ∙ Stephen Ash, BSc ∙ Prof F D Richard Hobbs, FMedSci ∙ Françoise S Howe, DPhil ∙ et al.
The Lancet Primary Care Published: September 9, 2025
DOI:https://doi.org/10.1016/j.lanprc.2025.100019
Summary
Background
Non-specific symptoms present a diagnostic challenge in primary care, and can be indicative of multiple benign and serious conditions, including cancer. Rapid diagnostic centre-based non-specific symptom pathways have been rolled out in the National Health Service across the UK as an urgent referral route. The Suspected CANcer (SCAN) Pathway was introduced as a non-specific symptom pathway pilot in Oxfordshire in 2017, and later adopted as standard of care in 2020. This study aims to describe the patients referred and outcomes during the first 6 operational years of the SCAN Pathway.
Methods
In this prospective cohort study, we collected data on all general practitioner (GP) referrals to the SCAN Pathway between March 31, 2017, and March 31, 2023. Patients are accepted onto the pathway if they are aged 40 years or older, with no other urgent referral pathway available, and are presenting to their GP with unexpected weight loss, severe unexplained fatigue, persistent nausea or appetite loss, new atypical pain, or unexplained test results, or the GP has a “gut feeling” that the patient has cancer. Through the pathway, patients undergo a CT of their chest, abdomen, and pelvis; a panel of blood tests; and a faecal immunochemical test. Here, we describe the referred cohort, pathway intervals, and outcomes and we present a predictive value of referral criteria and laboratory test abnormalities for cancer.
Findings
Of 4823 referrals accepted to SCAN during the study period, 2738 (56·8%) were for female patients and 2085 (43·2%) for male patients; mean age was 69·8 years (SD 12·7); patients were of Asian ethnicity in 183 (3·8%) referrals, Black in 62 (1·3%) referrals, mixed ethnicity in 39 (0·8%) referrals, other ethnicity in 64 (1·3%) referrals, and White in 4291 (89·0%) referrals. 423 (8·8%) referrals led to diagnoses of 429 cancers and 527 (10·9%) to non-cancer diagnoses. 933 (19·3%) referrals detected clinically significant incidental findings. The most common cancers were lung (85 [19·8%] of 429), pancreatic (47 [11·0%]), colon (43 [10·0%]), breast (35 [8·2%]), and non-Hodgkin lymphoma (34 [7·9%]). Cancer diagnoses occurred within 28 days of referral in 164 (38·8%) of 423 cases, with a median interval of 37 days (IQR 1–420) from referral to diagnosis. Non-cancer diagnoses occurred within 28 days of referral in 192 (36·4%) of 527 cases, with a median interval of 44 days (2–879) from referral to diagnosis. Samples were biobanked from consenting patients in 1645 (34·1%) referrals. The unexplained test results referral criterion had the highest positive predictive value (PPV) for cancer (12·5% [95% CI 11·0–14·1]). The combination of unexplained test results and nausea or appetite loss gave the highest PPV for cancer (18·5% [15·1–22·3]). An abnormally high CA125 had the highest PPV among all blood tests (29·7% [21·0–39·6]) and was associated with subsequent diagnosis of pancreatic, lung, ovarian, colorectal, and breast cancer.
Interpretation
CT-led non-specific symptom pathways can identify a relatively high proportion of patients with cancers that are harder to diagnose, but also a similar proportion of patients with an incidental finding as those diagnosed with cancer and non-cancer disease combined. Longer-term follow-up of patients referred to non-specific symptom pathways and robust comparison with other routes to cancer diagnosis will be needed to identify the impact on patient outcomes.
Funding
Cancer Research UK, MacMillan Cancer Care, NHS England, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (formerly Oxfordshire Clinical Commissioning Group), Oxford Cancer Centre, Oxford Molecular Diagnostics Centre, NIHR Oxford Biomedical Research Centre, Wellcome Trust, and NIHR Policy Research Programme (Policy Research Unit on Cancer Awareness, Screening and Early Diagnosis).
