Are GP referrals always so alarmist?

[MarisPiper92]

Grateful for any similar experiences. Earlier this week I went for a smear, and the nurse couldn't complete the test because my cervix was so bloody. She had a quick conversation with a doctor, and put me on the 2 week referral pathway for a colposcopy. I know people get 2-week referrals all the time, but the doctor's letter to the hospital reads as follows:

"Dear Colleague,
Thank you very much for seeing this lady with suspected cervical cancer. Please find attached the relevant referral form"

Do they always say this? Are they seriously concerned, or is this kind of phrasing standard practice? I've been lucky to have had good health my whole life, and have had very little contact with hospitals so far, and I'm trying to work out how worried I need to be.

The 2WW pathway is for referrals relating to cancer. The referral won’t be accepted if they don’t at least mention it. You’ll have to ask them if they think it’s a ‘likely’ or ‘just to exclude’ cancer referral.

I'm an HCP & send 2WW refs, yes, particularly at the moment if I don't make it sound dire then the risk is my referral gets downgraded to a lower pathway with long waiting time. I do now explain this to my patients that I have to make the situation sound the worst possible scenario to get them seen.

If it was a 2ww referral then it was for suspected cancer. Every person seen in that clinic is suspected as having cancer and is being investigated to see if they do have cancer.

The doctor was just being accurate.

Unfortunately the initial triage of referrals is often not done by clinicians. If you don't mention a possible cancer then the referral is quite often taken off the 2 week referral pathway.
Most referrals I've done I do not think are nasty but need to be sure . Unfortunately routine referrals can take months/years so as a previous poster has said you've got to mention cancer as a possible diagnosis.

Thanks very much everyone. I'm trying to mentally prepare for a worst-case scenario, but it is reassuring to know that it's standard to use pretty stark language.

I suspect it’s more a case of “this could be cancer” as opposed to “we suspect this is cancer”. The 2 week referral path does not mean it is likely you have cancer, just that it is one of the possibilities.

Yep, they are awful op, no bedside manner whatsoever.

I got referred under a 2ww a few months ago for "high liklihood of throat cancer" and it turned out to be muscular related which the consultant said they'd have realised if they bothered to ask me more than just "how long has this been going on" 🙄 I was in and out of my gp appointment for that in less than 3 mins. Consultant did not hide that he was pretty pissed off (not at me!)

Also had a lovely receptionist once tell me my symptoms sounded like it was probably cancer so no wonder I'm so worried. It was cervical ectropian.

Pretty standard. Dh had one fro dermatology and GP said ‘I’m going to write cancer but we know it isn’t’ type scenario.

Yeah I had one in similar circumstances with similar wording - although they were correct in my case, I think something like 90% of referrals under the two week pathway end up being something other than cancer. It did cause me a panic too, but what they're really doing is ruling it out.

Hope all goes well with it.

This sounds completely normal - there is no place for euphemisms in medical care, because that is how mistakes are made.

IME it is completely different in private health care so suspect its more to do with time/resources or sometimes just a lack of consideration for the human being receiving a copy of the letter.

I understand the time/resources issue, but even at one finger typing speed it takes about 30 seconds to type "with symptoms that require further investigating under the 2ww" or similar. Same thing but is a bit less shocking to read.

They have to suspect cancer until it's shown not to be with certain symptoms. So it doesn't matter how unlikely it is, if you tick the box, that's what they say. I had a 2WW referral for a breast lump. Within moments of arriving in the room at clinic, the doctor said 'I'm certain this isn't cancer.' I had all the tests and she confirmed it wasn't cancer. If they did it any other way, they'd potentially miss cancers which would be devastating.

While not cervical cancer related, your letter is on a par with mine which also says urgent half a dozen times.

I have been getting lumps (in my breast) for over thirty years, so am well-versed in referral letters. However, my latest lump, for which I have been referred for further investigation came with a letter full of alarmist language as well as a suspected cancer pdf, the latter of which is something I have never been sent before, and have no need of (as I've been down this path before and know the process). Even so, it is freaking me out, something I don't need, particularly as I'm 99.99% sure it is just a harmless fibroadenoma.

Referrals never used to be like this, at least mine never were. It's really frightening. While I understand the need for the GP to state is could be cancer and time is of an essence, I wish there was a happy medium that wasn't so alarmist.

Keeping everything crossed for you OP.

I had a private MRI which showed a small benign growth. GP saw report and referred me under 2 week pathway with suspected brain tumour.
He was doing his best for me but it was unsettling to see it written down.
NHS MRI has reached same conclusion as first one.

Unfortunately , as I said before , it is mostly non clinical staff who do the first sort of referral letters. In my area , even if you refer under 2 week rule (which isn't anymore , it's around 4 weeks here) unless you specifically mention cancer it will not be put on the urgent list , it will be on the routine list.

The vast majority of things you refer will not be cancer but there are always symptoms etc that catch you out. Far better to be over cautious than miss something.

Here is one of the guidelines for two week referral

The ‘two week waiting time standard’ was introduced in ‘new NHS’ and guarantees that everyone with suspected cancer will be able to see a specialist within two weeks of their practitioner deciding that they need an urgent referral.
In order to deal with these cases appropriately, all referrals from practitioners in this category must be:

• Marked urgent
• Mention ‘cancer’ or ‘treat under the two week standard’

I went to my (new) GP because an odd looking mole was itching. I have a history of skin and other cancers; this was the first time we met so told him I want absolute openness about investigations and diagnosis.

He agreed the mole was odd and suspect. Said he was going to refer me to a dermatologist and mark it "urgent, cancer risk" for a two-week response time.

Which is exactly what I wanted him to do, and what happened. Time from showing GP to seeing Consultant and hospital excision for biopsy, 5 weeks.
It was benign.

Thanks all, you've calmed me down a lot. I have a cervical ectropion which I suspect was the cause of the bleeding at the smear, but it's good to be in the system to make sure.