Introduction: The UK government introduced the two-week rule (TWR) to improve the diagnosis and treatment of gastrointestinal
(GI) cancers. This updated review systematically identifies new articles since 2009 and presents an overview
of the previous and new findings combined for both upper GI cancer (UGCs) and colorectal cancers (CRCs).
Methods: We analysed all peer-reviewed articles and conference abstracts with GI cancer detection rates following TWR
referral and/or the proportion of TWR-referred GI cancers from the total number diagnosed during the study period. We
reported average cancer detection rates and split the data according to four time periods to determine whether TWR effectiveness
improved over time.
Results: The average cancer detection rate by the TWR for all studies was 11.6% for CRC and 8.3% for UGC. We found
a decrease in cancer detection rates over time for CRC from 14.4% in 2000-2002 to 7.2% in 2009-2012. However, UGC
detection rates increased over time from 8.5% in 2000-2002 to 11.4% in 2005-2008. We found that on average, 30.8% of
CRCs and 28.8% of UGCs were detected following referrals using the TWR system and that these proportions had increased
over time from 30.6% to 38.4% for CRC and from 26.8% to 52% for UGC.
Conclusion: The TWR is not still sufficiently effective in diagnosing GI cancers in patients, suggesting that the referral
guidelines need to be improved. Our findings do suggest that the TWR is being used more frequently than alternative