Rapid Cancer Diagnostic Service: Information to support visions from the cancer strategy
1 January to 31 December 2024

About this release

This release by Public Health Scotland (PHS) has been developed to provide annual updates on Rapid Cancer Diagnostic Services (RCDSs) to support the delivery of the Cancer Strategy for Scotland 2023-2033 actions. The creation of RCDSs was a strategic ambition within the strategy, as part of the "enhance diagnostics" actions, with the action being to "expand and evaluate Rapid Cancer Diagnostic Services to ensure population-based coverage". RCDSs provide primary care with an alternative, person-centred and fast-tracked pathway to refer patients with non-specific symptoms (such as weight loss, fatigue and nausea) that are suspicious of cancer.

Six health boards in Scotland currently have an RCDS, these are: NHS Ayrshire & Arran, NHS Borders, NHS Dumfries & Galloway, NHS Fife, NHS Forth Valley, and NHS Lanarkshire. In 2024, five of the boards had complete data covering the reporting period: 1 January - 31 December 2024. NHS Forth Valley's RCDS started in May 2025, therefore their RCDS data are not included in this report. The figures reported represent the five boards combined and are not representative of Scotland as a whole.

Main points

• In 2024, 3,434 RCDS referrals were received across the five NHS boards; a referral was then either 'accepted', 'declined' or, 'redirected'.
  • 78.7% (2,704) were accepted onto the RCDS pathway.
  • The referrals declined or redirected have specific reasons for being excluded from the pathway following expert clinical triage: 'Declined' includes 'patients who do not meet RCDS criteria' and 'patients unfit for pathway'. 'Redirected' includes 'patients who meet criteria for a cancer site-specific pathway', 'patients where a serious non-cancer diagnosis is highly likely', 'patients seen by RCDS within last 3 months with no new symptoms' or 'previous cancer diagnosis and symptoms likely to be due to a recurrence'.
  • 389 (11.3%) referrals were 'declined' for the RCDS pathway following expert clinical triage; 86.6% of these patients 'did not meet RCDS criteria'.
  • 341 (9.9%) referrals were 'redirected', 93.5% of these patients were redirected to a 'cancer site-specific pathway'.
• A higher proportion of females were referred - 56.6% to 43.4% male.
  • The median age of all patients referred was 68 years. A higher age was observed in patients who were diagnosed with cancer (median age of 73.5).
• Around a quarter (25.2%) of all referrals lived in the most deprived areas of Scotland (Scottish Index of Multiple Deprivation 2020, SIMD Quintile 1), compared to 13.1% who lived in the least deprived areas (SIMD Quintile 5).
• For the 2,704 accepted onto the RCDS pathway, the top five main presenting symptoms recorded were: 'unexplained weight loss' (73.4%), 'new unexplained pain (abdominal /back/bone)' (7.4%), 'severe unexplained fatigue' (5.9%), 'other' (5.6%), and 'new unexplained laboratory results' (3.5%).
• Of the patients accepted onto the pathway, 2,389 had completed the pathway when the data snapshot was taken (315 patients terminated the pathway before completion or are still undergoing investigations).
  • of these patients, 222 patients were diagnosed with cancer (a 9.3% conversion rate), patients with this outcome receive an onward referral to a cancer site-specific pathway.
  • A non-cancer or no diagnosis outcome was given to the remainder of patients (64.3% and 26.4% respectively). These patients were then either redirected to another NHS service or redirected back to their GP.
  • A range of cancer types were diagnosed. Lung cancer was the most common (20.7%) followed by lymphomas and colorectal cancer (12.2% and 10.8% respectively).
• For the 2,389 patients with a completed pathway, the overall median time from referral date to outcome date was 25 days (Inter-quartile range (IQR) 12-42 days; mean 29 days).
  • For the 222 patients diagnosed with cancer, the median time from referral to outcome was 15 days (IQR 10-32 days; mean 21 days).

Background

RCDSs provide primary care with a new fast-track diagnostic pathway for patients with non-specific symptoms (such as fatigue, nausea and weight loss). These patients can often experience lengthened pathways and delayed diagnoses given the vague nature of symptoms, which cross-over with multiple conditions. The Boards without a RCDS use different referral routes for patients with non-specific symptoms, as reflected in the recently updated Scottish Referral Guidelines for Suspected Cancer. This includes GPs being able to directly access a CT scan for their patients; these data are not included in this publication

The RCDS data is a snapshot: therefore, the data presented here may differ from future published data relating to the same period.

Further information

The next release of this publication will be December 2026.