The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: a systematic literature review

BMC Health Serv Res. 2006 Apr 3;6:43. doi: 10.1186/1472-6963-6-43.


Background: The Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral. Guidelines were available to GPs to facilitate the appropriate TWR referral of patients exhibiting high-risk CRC symptoms.

Methods: We aimed to evaluate the TWR and its CRC detection rate on NHS CRC diagnostic services by performing a literature search and critically appraising the peer-reviewed studies. Only 12 studies were eligible for inclusion. Data was collected and overall results were given as weighted averages.

Results: The studies identified indicated that only 10.3% of patients referred by the TWR were eventually diagnosed with CRC. When examining the referral origin of all CRC patients diagnosed during the time of the studies, 24% had been referred using the TWR, 24.1% were referred as emergency cases, and 52.4% were referred using alternative routes. No evidence was found to indicate that the TWR had resulted in identifying CRC patients at an earlier, more treatable stage of their disease.

Conclusion: The TWR referral system needs to be improved to increase the number of CRC patients referred using this fast track method as they present to their GP. The TWR and new NICE Guidelines for the referral of patients with suspected cancer should be independently evaluated.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Colorectal Neoplasms / diagnosis*
  • Diagnostic Services / statistics & numerical data*
  • Early Diagnosis
  • England
  • Hospitals, Public / standards*
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Medicine / standards*
  • Medicine / statistics & numerical data
  • Practice Guidelines as Topic*
  • Referral and Consultation / standards*
  • Risk Factors
  • Specialization*
  • State Medicine / standards*
  • State Medicine / statistics & numerical data
  • Time Factors
  • Wales