The two-week-wait cancer initiative in urology: useful modernization?

The two-week-wait cancer initiative in the UK was designed to speed referral of patients suspected of having cancer and, by so doing, improve their outcome. We reviewed the case notes of all patients referred under this scheme to a single urology department over twelve months. In the department, nearly one-third of new outpatient appointments came under this scheme. 124 patients were referred and all but 7 were seen within the 14-day deadline. In 62 the reason for referral was haematuria, which was macroscopic in 42. Of those with macroscopic haematuria 6 proved to have cancer, newly diagnosed in 4 (2 bladder, 2 renal); no patient with microscopic haematuria had cancer. Of 35 referred with a raised prostate-specific antigen 11 had prostate cancer, in most cases beyond cure. Cancer was found in 1 of 19 patients referred with a testicular mass. In patients referred under the two-week-wait scheme with macroscopic haematuria, cancer is common. Microscopic haematuria is seldom significant. Carcinoma of the prostate is usually advanced and beyond cure at presentation. Among patients referred with scrotal lumps, cancer of the testis is not common. The scheme as a whole is unlikely to improve cancer outcomes. Patients with macroscopic haematuria might be better served by one-stop clinics. For those with testicular lumps, most of which will be benign, the best answer might be direct general practitioner access to scrotal ultrasonography.