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New NICE guidance on referral for cancer

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3640 (Published 03 July 2015) Cite this as: BMJ 2015;351:h3640

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Re: New NICE guidance on referral for cancer

The subheading on this editorial is worthy of comment. The author is correct in pointing to the "not less is more" nature of the new guideline, however my concern is with the term "evidence based". The term is clearly broad enough to be correctly used in this context but this serves to highlight the limitation of the term itself.

Firstly the risk threshold of 3%, a crucial foundation of the guideline, is clearly not evidence based.

Secondly, there is no attempt to include the evidence of the negative impacts associated with the investigations generated through the process. There will be different risks assocaited with the appropriate follow up investigations for differernt synptoms. Including the liklihood of these negative consequences would provide the clinician with key evidence to consider in applying the guideline.

Maybe some evidence but enough would be a better byline for this editorial.

Competing interests: No competing interests

08 July 2015
Alan Katz
Family Physician
University of Manitoba
408-727 McDermot Ave Winnipeg, Manitoba R3E 3P5 Canada
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