Cancer diagnosis in primary care

Abstract

Around a quarter of those in the developed world die of cancer. Most cancers present to primary care with symptoms, even when there is a screening test for the particular cancer. However, the symptoms of cancer are also symptoms of benign disease, and the GP has to judge whether cancer is a possible explanation. Very little research examined this process until relatively recently. This review paper examines the process of primary care diagnosis, especially the selection of patients for rapid investigation. It concentrates on the four commonest UK cancers: breast, lung, colon, and prostate as these have been the subject of most recent studies.

Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic study

“…The present authors, like others, 10 have been puzzled to note that Danish and British citizens have a poorer cancer prognosis than citizens from other countries, even though treatment regimes are apparently comparable and all of high quality. For the UK, it has been stated that 5000-10 000 patients with cancer die each year due to delays in diagnosis.…”

How frequently do young people with potential cancer symptoms present in primary care?

“…24 Rather, the diagnosis may emerge after more than one visit, in which signs and symptoms are observed over a period of time, and information from investigations and other sources is obtained. A substantive body of research highlights the unique biological, cognitive, and psychosocial characteristics of teenagers and young adults who moderate their use of primary care services; 25 as a result of this moderation, it is a particular challenge for primary care providers to capitalise on opportunities for diagnosis in this population.…”

Patients' confidence in their GP before and after being diagnosed with cancer

“…It is well known that dealing with cancer symptoms in general practice is complex, especially because of low positive predictive values and a high number of non-specific symptoms. 9 These challenges may extend the interval between the patient's first presentation of symptoms to the GP and the GP's initiation of a cancer-specific investigation -an interval that is also referred to as doctor delay. International findings indicate that factors such as the GP's knowledge of the patient and the GPpatient relationship are associated with the patient's confidence in the GP, and that problems with obtaining a referral to specialist care can undermine the patient's confidence in the GP.…”