Rapid Cancer Diagnostic Service: Information to support visions from the cancer strategy
1 January to 31 December 2025

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. Five of the boards had complete data covering the full reporting period: 01 January - 31 December 2025. NHS Forth Valley's RCDS started in May 2025, their RCDS data from this period onwards are included in this report.  The figures reported represent the six boards combined and are not representative of Scotland as a whole.

Main points

• NHS Ayrshire & Arran, NHS Borders, NHS Dumfries & Galloway, NHS Fife, and NHS Lanarkshire had complete data covering the full reporting period 1 January 2024 - 31 December 2025. NHS Forth Valley's RCDS started in May 2025, their RCDS data from this period are also included in the total for 2025. These six boards combined are shown as the total.
• In 2025, 4,439 RCDS referrals were received, a referral is either 'accepted', 'declined' or, 'redirected ', (3,434 referrals were received in 2024).
• In 2025, 77.6% (3,446) were accepted onto the RCDS pathway, (78.7% (2,704) were accepted in 2024).
• 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'.
• In 2025, 588 (13.2%) referrals were 'declined' for the RCDS pathway following expert clinical triage; 81.8% of these 'patients did not meet RCDS criteria'. In 2024, 389 (11.3%) were 'declined' and 86.6% of these 'patients did not meet RCDS criteria'.
• In 2025, 405 (9.1%) of referrals were 'redirected', 91.9% of these patients were redirected to a 'cancer site-specific pathway'. In 2024, 341 (9.9%) of referrals were 'redirected', 93.5% were redirected to a 'cancer site-specific pathway'.
• A higher proportion of females were referred in 2025 - 56.5% compared to 43.5% male, this is similar to the proportion observed in 2024.
• In 2025 the median age of all patients referred was 68 years (a median age of 68 years was also observed in 2024). A higher median age was observed in patients who were diagnosed with cancer, 75 years (73.5 years in 2024).
• In 2025, 25.1% of all referrals lived in the most deprived areas of Scotland (SIMD Quintile 1), compared to 13.1% who lived in the least deprived areas (SIMD Quintile 5). The proportions for those living in the most and least deprived areas were similar in 2024.
• For the 3,446 (2,704 in 2024) patients with an accepted referral, the top 5 main presenting symptoms recorded in 2025 were:
  • 'unexplained weight loss' (72.7% in 2025 compared to 73.4% in 2024)
  • 'new unexplained pain (abdominal /back/bone)' (7.4% in 2025 and 2024)
  • 'severe unexplained fatigue' (5.7% in 2025 and 5.9% in 2024)
  • 'other' (5.4% in 2025 and 5.6% in 2024)
  • 'persistent nausea or appetite loss' (2.6% in 2025), this symptom was not one of the top 5 main symptoms in 2024, the fifth symptom recorded was ' new unexplained laboratory results' (3.5%).
• Of the patients accepted onto the pathway in 2025, when the data snapshot was taken, 2,833 had completed the pathway (2,391 in 2024) and 577 patients terminated the pathway before completion or are still undergoing investigations (287 in 2024).
• Of those accepted onto the pathway 239 patients were diagnosed with cancer in 2025 compared to 222 in 2024 (an 8.4% conversion rate compared to 9.3% in 2024), 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 (65.8% and 25.7% respectively in 2025 and 64.2% and 26.5% respectively in 2024). 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 (20.5% in 2025 and 20.3% in 2024) followed by UGI - HPB (13.0% in 2025 and 5.9% in 2024), then lymphoma (12.1% in 2025 and 12.2% in 2024). UGI - HPB has taken over as the second most common cancer diagnosed in 2025, while lymphoma was in second position in 2024.
• For the 2,833 patients with a completed pathway in 2025 (2,391 in 2024), the overall median time from referral date to outcome date was 27 days (Inter-quartile range (IQR) 14-40 days). In 2024, the overall median time from referral date to outcome date was 25 days (Inter-quartile range (IQR) 12-42 days).
• For the 239 patients diagnosed with cancer (222 in 2024), the median time from RCDS referral to outcome was 17 days (IQR 12-34 days). In 2024 the median time from RCDS referral to outcome was 15 days (IQR 10-32 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.

Data for 2024 and 2025 are presented in this publication and data files are available in the data section of the publication page.

Further information

The next release of this publication will be September 2027.