Delay in the Detection of Cancer: A Review of the Literature

Abstract

University of the Negev , Beersheba THE EXISTING KNOWLEDGE ABOUT DELAY The Consequences of DelayIt would be easy to compile an impressive list of quotations testifying to the importance of cutting down the delay which precedes therapeutic action for cancer patients. Dominant professional opinion tends to coincide with common sense in arguing that the earlier the patient gets to the therapist, the more likely is his life to be saved. Thus, for example, Wiggins et al '°' estimated that the overall five-year cancer survival rate of 25 percent in upstate New York could be doubled if all cases were treated early. In 1954, the medical and scientific director of the American Cancer Society, Charles Cameron, said that two out of every four people diagnosed with cancer in the next year could be saved by current methods of treatment. However, he went on to say that only one of those would be saved. The other would delay seeking help until his disease had progressed too far for him to be helped by even the most modern methods.&dquo;As a starting point in our review of the literature, we felt it important to subject this view to the test of evidence. MacDonald's 61 survey in 1951 of 236 articles that made more than passing reference to the significance of early treatment revealed that only 16 contained data that made it possible to correlate end results with early treatment. Moreover, in his opinion, most of these 16 &dquo;failed to establish any significant value for early treatment.&dquo; Most of the literature contained little more than stereotyped allusions to the desirability of early *This paper has been prepared in the course of a study on participation and nonparticipation in breast cancer detection examinations.

Illness behavior in rheumatoid arthritis

“…Normalization was the predominant causal attribution, which is consistent with findings of attribution studies in RA. (16)(17)(18) as well as other diseases (6,19,20). Subject responses or actions related to initial symptoms were consistent with the meaning attached to symptoms.…”

Patient delay for potentially malignant oral symptoms

“…Presumably, knowledge about oral cancer aids more accurate symptom interpretation and the decision to seek help. Although it is recognized that knowledge alone may not be sufficient [as presumably knowledge interacts with affective reactions, conceptualizations of cancer, and other factors (42, 43)], the association between knowledge and patient delay has implications for information provision about cancer to those at risk of developing the disease. Promisingly, a leaflet has been shown to increase knowledge of oral cancer and intention to agree to an oral cancer screen (44).…”

Genetic detection: the need for psychosocial support in modern cancer prevention

“…In order to reach the persons who could benefit from genetic information, public information and education is crucial. Prior experience with public education and information [3] indicates that knowledge about "cancer symptoms" is a necessary, but not sufficient factor in seeking help, and that the way persons deal with such information is influenced by a variety of psychosocial variables. We also know from experience with Huntington's disease that prior to the possibility of genetic testing 75% of persons at risk indicated that they would be interested in such a test, but only 20% have requested a test after it has been established [4].…”