Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival?

Aim: To determine current delays in diagnosis and treatment of bowel cancer, when and why they occur, and what effect they have on survival.

Method: A detailed review of the literature based on the development of the GP referral guidelines in 2000.

Results: There is no evidence of a reduction in the delay to diagnosis and treatment of bowel cancer over the last 60 years. There is no strong theoretical basis for a benefit from earlier diagnosis of symptomatic bowel cancer and this is consistent with observational studies.

Conclusion: Campaigns to earlier diagnose bowel cancer will not be successful unless new strategies are developed. There is substantial evidence that earlier diagnosis of symptomatic bowel cancer will not improve survival in the majority of patients. However as excessive delays still occur in some patients it is reasonable to continue to aim to diagnose and treat all bowel cancer within 6 months of the onset of symptoms with an overall median of 3-4 months.