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The Swedish fast-track diagnostic pathway was applied during 2017 for 146 patients with serious non-specific symptoms including weight loss, fatigue and anemia. Within five days all patients had a physical examination and a decision was made of radiologic investigations. The waiting time was short for e.g. CT-scan of the abdomen and thorax. A diagnosis of a malignant condition was made in 38 patients (26%) with a median age of 75 (48-91) years. There were 24 men and 14 women. Most common diagnoses were lung cancer and colorectal cancer. Hematologic malignancy was diagnosed in 8 patients. Stage IV disease occurred in 17 of the patients with carcinoma (57%). About 60 benign main diagnoses were made in 108 patients without malignant disease. Two of them have developed cancer during 2018 (breast cancer, pancreatic cancer).

The British national Institute for Health and Care Excellence (NICE) has presented guidelines based on signs and symptoms which should raise a suspicion of colorectal cancer. A slightly modified version of these guidelines, adapted to Swedish conditions, named Swedish NICE (sNICE) criteria, was implemented at eight primary care centres. By following the sNICE criteria, cases with higher degree of suspicion of colorectal cancer were advised for computer tomography (CT) of the colon, whereas cases of low degree of suspicion were advised for the considerably less time and patient demanding CT of the abdomen. For patients with isolated anal symptoms without presence of sNICE criteria, active expectancy for six weeks was recommended, followed by renewed consideration. Results showed that the ratio between CT colon and CT abdomen was reduced from 2.2 to 1.1 after introduction of the sNICE criteria. Also, the proportion of patients undergoing CT colon within two weeks from admittance was increased from 3 to 25 %. We conclude that the sNICE criteria may be a useful supportive tool for the primary care physician.