Press release

Poorer outcomes for oesophageal and gastric cancer linked to ‘huge variation’ in endoscopy referral rates between GP practices

Patients from GP practices with low endoscopy referral rates are at increased risk of poor outcomes from oesophageal and gastric cancers.

Stomach pain

Stomach pain

Patients from GP practices with low endoscopy referral rates are at increased risk of poor outcomes from oesophageal and gastric cancers according to research presented at Public Health England’s National Cancer Intelligence Network annual conference.

Research from the Department of Gastoenterology at the University of Liverpool has found that there is a wide variation in rates of elective upper gastrointestinal endoscopy between GP practices across England.

The team studied 22,488 new cases of oesophageal and gastric cancer from 6,513 general practices. Their research showed that average referral rates for endoscopy varied by 250%.

Patients belonging to practices with low rates of endoscopy referral were shown to be at increased risk of a poor outcome as reflected in higher rates of emergency admission for diagnosis, lower rates of potentially curative surgery and poorer 1 year survival rates. This inequality was most marked in practices serving deprived populations where those in the low referring group had the poorest cancer outcomes in the country.

Dr Keith Bodger, Consultant Gastroenterologist at Aintree University Hospital in Liverpool, said:

Sadly, most tumours of the oesophagus or stomach are incurable by the time of diagnosis in the UK. Early symptoms may be mild or indistinguishable from the common benign causes of indigestion. Current NICE guidelines advise a conservative approach to investigating stomach symptoms, reserving gastroscopy for older patients or those with established ‘red flag’ or ‘alarm’ symptoms.

Our research shows that general practices in England vary substantially in their rates of gastroscopy and that low rates are associated with a risk of poorer outcomes for oesophageal and gastric cancer. This inequality is worst for those living in the most deprived areas of the country. Targeted interventions may be required for local populations having inappropriately low rates of investigation.

Dr Mick Peake Clinical Lead at Public Health England’s National Cancer Intelligence Network, said:

Rates of referral for endoscopy from primary care show wide variation suggesting a spectrum of clinical practice and differing interpretation of guidelines.

Whereas outcomes for many cancers have improved over the last decade, progress has been limited for tumours of the oesophagus and stomach and early stage diagnosis remains challenging. The research has highlighted not only significant differences but also inequalities. GP practices with low rates of endoscopy referral should review their current practice, particularly those serving deprived populations. Patients wherever they live should be given the best possible chance of a successful outcome. Increasing endoscopy rates and ensuring the right patients are referred early would be likely to significantly improve the outcomes for patients with oesophageal and stomach cancers.

Notes to Editor

  • A endoscopy (also known as a gastroscopy) is a medical procedure during which a thin, flexible tube called an endoscope is used to look inside the stomach. The endoscope has a light and a camera on one end. The camera is used to relay images of the inside of the body to a television monitor. More than half a million endoscopies are performed by the NHS each year in England.
  • One year survival rates for cancer of the oesophagus is approximately 40%, and 5 year survival is around 13%.
  • One year survival rates for gastric cancer is approximately 40%, and 5 year survival is around 17%.

About Public Health England

Public Health England is a new executive agency of the Department of Health that took up its full responsibilities on 1 April 2013. PHE works with national and local government, industry and the NHS to protect and improve the nation’s health and support healthier choices and will be addressing inequalities by focusing on removing barriers to good health. To find out more visit our website, follow us on Twitter @PHE_uk.

About the National Cancer Intelligence Network (NCIN), operated by Public Health England

  • The NCIN was established in June 2008 to coordinate the collection, analysis and publication of comparative national statistics on diagnosis, treatment and outcomes for all types of cancer
  • The NCIN is a UK wide partnership funded by multiple stakeholders
  • The NCIN will drive improvements in the standards of care and clinical outcomes through exploiting data
  • The NCIN will support audit and research programmes by providing cancer information and patient care will be monitored through expert analyses of up-to-date statistics
  • For more information please visit and
Published 13 June 2013