A major UK study, led by researchers at the University of Oxford's Nuffield Department of Primary Care Health Sciences , Oxford University Hospitals NHS Foundation Trust , the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre , and Oxford Cancer , has provided the most comprehensive analysis to date of a cancer diagnosis pathway for patients presenting with non-specific symptoms (NSS), such as unexplained weight loss or fatigue. These symptoms can indicate a wide range of conditions, from benign diseases to late-stage cancers, making timely and accurate diagnosis a significant challenge in primary care.
The study, published in the Lancet Primary Care , tracked over 4,800 patients referred to the SCAN Pathway between 2017 and 2023.
SCAN was originally developed in Oxfordshire in partnership with NHS England, Cancer Research UK and Macmillan Cancer Support; it aimed to accelerate and streamline cancer diagnosis for patients with symptoms that fall outside standard urgent referral guidelines. Since 2020, it has been adopted as standard care across the region and is part of the NHS's wider rollout of Rapid Diagnostic Centres nationwide.
Early diagnosis of cancers could save thousands of lives each year and significantly reduce treatment costs for the NHS, as late-stage cancer care is considerably more expensive.
Key findings:
• Over the six years tracked, 8.8% of patients were diagnosed with cancer, most commonly lung, pancreatic, breast, non-Hodgkin lymphoma, and colorectal.
• An additional 10.9% received serious non-cancer diagnoses.
• 19.3% had clinically significant incidental findings, underscoring the complexity and resource demands of these pathways.
• Certain combinations of symptoms and test abnormalities significantly increased the likelihood of a cancer diagnosis. For example, abnormal CA125 levels (a protein found in the blood which can be used as a biomarker for detecting some cancers) had a 29.7% positive predictive value for cancer.
Dr Claire Friedemann Smith , joint first author and researcher at the Nuffield Department of Primary Care Health Sciences , University of Oxford, said: 'Our findings support the value of non-specific symptom pathways like SCAN in identifying hard-to-diagnose cancers, but they also highlight the considerable number of incidental findings that can place additional pressure on healthcare systems. This study gives vital insights for clinicians, commissioners, and policymakers aiming to improve early diagnosis without overwhelming services.'
The study's extended time frame also allowed researchers to assess how patient characteristics, outcomes, and pathway performance evolved from its initial pilot phase to full integration into routine NHS care.
This evidence reinforces the importance of appropriately resourcing NSS pathways, especially as similar diagnostic models are adopted across the UK and internationally. The study also calls for further research into the cost-effectiveness of these pathways, particularly in light of the substantial number of non-cancer findings and lack of stage shift in cancers diagnosed.
Dr Brian D Nicholson , joint first author and researcher at the Nuffield Department of Primary Care Health Sciences , University of Oxford, added: 'We are pleased to present the findings from SCAN's first six years. There is a careful balance to strike when intensively investigating non-specific symptoms between the identification of disease caused by the symptom that requires immediate treatment and incidental findings of unknown significance. Using our research database we will now work to identify the additional serious diseases detected during the follow-up of incidental findings to help optimise non-specific symptom pathways in the NHS.'
The full paper, ' 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 ', is published in the Lancet Primary Care .
