Improving early diagnosis of symptomatic cancer

Abstract

| Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. This Review examines expedited diagnosis of cancer from four perspectives. The first examines the potential for benefits from expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in primary care, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for this. UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of the subject are reviewed, although few studies provide definitive evidence on this topic.In all developed countries, much time, effort and finance is spent on the diagnosis of cancer.

Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records

“…This discrepancy is attributed in part to late diagnosis, which is generally thought to contribute to advanced stage at diagnosis, and thus to the poorer survival observed (Hamilton et al , 2016). Shortening the diagnostic interval (i.e., the time between presenting with a symptom of cancer and ultimate diagnosis; Weller et al , 2012) was made a specific government public policy priority in Improving Outcomes: A Strategy for Cancer (Government, 2011).…”

Detecting cancer in primary care: Where does early diagnosis stop and overdiagnosis begin?

“…Most are diagnosed after symptomatic presentation to primary care (Elliss‐Brookes et al., ). Experts acknowledge that overdiagnosis could exist as a consequence of early diagnosis initiatives but, whilst the risks are considered minor in comparison to the benefits of early detection, the scale and seriousness remain poorly understood (Hamilton, Walter, Rubin, & Neal, ; Neal et al., ; Rubin et al., ).…”

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

“…1 National guidelines encourage primary care clinicians/ general practitioners (GPs) to act on 'alarm' symptoms, such as haemoptysis or rectal bleeding, and to refer patients with these symptoms rapidly for specialist investigation. 2,3 However, half of patients with cancer present with non-specific symptoms, such as unexpected weight loss, that do not point to a specific cancer site. 4,5 These patients have longer times to diagnosis, are less likely to be referred urgently, and more likely to be diagnosed as an emergency or at an advanced stage.…”