ArticleAnnals of the Royal College of Surgeons of England2009
Audit of two-week rule referrals for suspected testicular cancer in Cornwall, 2003-2005.
Article in Annals of the Royal College of Surgeons of England, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method.BMC health services research · 2017Pooled it
- Impact and Risk Factors of Diagnostic Delay in Patients With Testicular Cancer: A Multicenter Retrospective Study.International journal of urology : official journal of the Japanese Urological Association · 2025Observational
- Characteristics of Optimal Cancer Referrals Made by Primary Care Clinicians: Scoping Review.Cancer control : journal of the Moffitt Cancer CenterArticle
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 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. PATIENTS AND
methodsWe 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.
resultsTesticular 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.
conclusionsThe 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.
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