Audit of two-week rule referrals for suspected testicular cancer in Cornwall, 2003-2005

The objective was to evaluate the two-week wait referral system for suspected testicular cancer and to compare waiting times from referral to treatment before and after the introduction of the two-week wait process.

We reviewed 241 case notes for patients referred under the two-week wait system with suspected testicular tumour during a complete 3-year period (2003-2005) and recorded information from the referral letter, findings in the urology clinic, results of ultrasound and final outcomes. We also identified 42 cases of testicular tumour treated during a complete 3-year period (1997-1999) just before the two-week wait system was introduced. The journey from referral to treatment for tumour cases was compared during these two periods.

Testicular cancer was only found in 8% of patients referred by the two-week wait system. We judged the referral to be inappropriate in 48% of cases. Of referred cases, 78% required no surgical treatment. There was a significant improvement of 9 days in the average time from general practitioner (GP) referral to urology clinic attendance but all other journey intervals remained the same.

The performance of GPs in examining scrotal swellings and applying the two-week wait guidelines was very poor, resulting in many unnecessary urgent clinic visits. The referral system speeds up the visit to a urology clinic but the overall effect is probably not of clinical significance. We suggest that it would be much more cost-effective for all these patients to have an ultrasound scan within 2 weeks instead of a urology clinic appointment.