{"entity":{"id":"idea-crc-uk-young-patient-referral-and-diagnostic-interval","kind":"idea","name":"UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is","aka":[],"tldr":"The fastest rise in bowel cancer is in people two decades younger than any screening programme, who reach diagnosis through symptoms, often after several visits. Screening cannot help them; the referral pathway can.","summary":"This is a placeholder for the UK-specific analysis written by the UK and NHS file of this deep dive, which owns the NICE NG12 referral criteria, the symptomatic faecal immunochemical test threshold, the faster diagnosis standard and the National Bowel Cancer Audit's route-to-diagnosis data. The evidence this roadmap contributes is the shape of the problem: incidence in people aged 20 to 29 rose 7.9 percent a year across 20 European countries between 2004 and 2016, the proportion of United States rectal cancers diagnosed under 55 doubled to 29.2 percent, and 60 percent of new cases were advanced at diagnosis in 2019 against 52 percent in the mid-2000s.\n\nBecause these patients are below every screening age, the only lever is the symptomatic pathway: how a young adult with rectal bleeding or a change in bowel habit is triaged, whether a faecal immunochemical test is used to rule out rather than to delay, and how many primary care contacts precede referral.","asOf":"2026-09-24","links":[{"label":"NICE NG12: suspected cancer, recognition and referral","url":"https://www.nice.org.uk/guidance/ng12"},{"label":"National Bowel Cancer Audit (NATCAN)","url":"https://www.natcan.org.uk/audits/bowel/"}],"tags":["colorectal-evidence"],"related":["colorectal-roadmap","idea-crc-early-onset-cause-hunt"],"cancers":["colorectal","early-onset-colorectal","rectal-cancer"],"sections":["early-detection"],"technologies":["colorectal-screening","colonoscopy"],"targets":[],"drugs":[],"companies":[],"institutions":["nice","cruk"],"pathways":[],"terms":["fit-test"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-care-fragmentation","b-knowledge-diffusion"],"keyPapers":["paper-vuik-early-onset-colorectal-europe-gut-2019","paper-siegel-colorectal-incidence-birth-cohort-jnci-2017","paper-siegel-colorectal-cancer-statistics-ca-2023"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"An age-aware symptomatic pathway for patients under 50 (explicit safety-netting, a faecal immunochemical test used as a rule-out with a defined follow-up, and direct-access investigation after a specified number of contacts) reduces the interval from first presentation to diagnosis and the proportion diagnosed as an emergency, without a material increase in colonoscopy demand.","rationale":"Early-onset cases present symptomatically and later-stage; the pathway, not the screening programme, is the only mechanism available to them, and route-to-diagnosis data already show emergency presentation is commoner in this group.","test":"To be specified by the UK and NHS file of this deep dive: a service evaluation against National Bowel Cancer Audit route-to-diagnosis and faster diagnosis standard data, followed by a cluster-randomised trial of the age-aware pathway in primary care networks, with time to diagnosis and stage at diagnosis as primary outcomes.","maturity":"early-clinical","actor":"policy","cost":"medium","horizonYears":4},"route":"/ideas/idea-crc-uk-young-patient-referral-and-diagnostic-interval/","neighbours":{"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}],"idea":[{"id":"idea-crc-early-onset-cause-hunt","kind":"idea","name":"Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further","route":"/ideas/idea-crc-early-onset-cause-hunt/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"},{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"colorectal-screening","kind":"technology","name":"Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)","route":"/technologies/colorectal-screening/"}],"term":[{"id":"colonoscopy","kind":"term","name":"Colonoscopy","route":"/terms/colonoscopy/"},{"id":"fit-test","kind":"term","name":"Faecal immunochemical test (FIT)","route":"/terms/fit-test/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"},{"id":"nice","kind":"institution","name":"National Institute for Health and Care Excellence","route":"/institutions/nice/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-knowledge-diffusion","kind":"bottleneck","name":"Knowledge reaches practice too slowly","route":"/bottlenecks/b-knowledge-diffusion/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-siegel-colorectal-incidence-birth-cohort-jnci-2017","kind":"paper","name":"Colorectal cancer incidence patterns in the United States, 1974-2013","route":"/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/"},{"id":"paper-siegel-colorectal-cancer-statistics-ca-2023","kind":"paper","name":"Colorectal cancer statistics, 2023","route":"/key-papers/paper-siegel-colorectal-cancer-statistics-ca-2023/"},{"id":"paper-vuik-early-onset-colorectal-europe-gut-2019","kind":"paper","name":"Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years","route":"/key-papers/paper-vuik-early-onset-colorectal-europe-gut-2019/"}]}}