Do patients with frank haematuria referred under the two-week rule have a higher incidence of bladder cancer?
BACKGROUND
The new NHS guaranteed that everyone with suspected cancer would be able to see a specialist within 2 weeks of their GP deciding that they need to be seen urgently. We investigated whether referrals under the two-week rule for frank haematuria results in a clinically significant advantage over normal referral pathways in patients with suspected bladder cancer.


METHODS
Patients referred for frank haematuria specifically under the two-week cancer rule were prospectively recorded over a 2-year period. Results of haematuria investigations were compared to a control group of routine frank haematuria referrals.


RESULTS
Of the 32 patients in each group, four bladder cancers were found in the 2-week rule group and five bladder cancers were found in the control group (P > 0.05). The number of other demonstrable urological causes of frank haematuria was also the same in the two groups.


CONCLUSIONS
The incidence of bladder cancer and other urological pathologies is the same irrespective of referral pattern. It is not clear whether seeing such patients within 2 weeks confers any clinically significant advantage over conventional referral pathways. Not all patients with macroscopic haematuria are referred or seen under the two-week rule, this has considerable clinical governance implications for all departments of urology.
Thiruchelvam
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Department of Urology, North Hampshire Hospital, Basingstoke, Hampshire, UK. n.t@talk21.com
Mostafid
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H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003558:Cystoscopy / Q000379:methods; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards*; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology