![]() Across both these selection processes the risk of cancer is higher in those who have been selected (understandably - as the selection process works, albeit imperfectly). 13 There are two selection processes when a patient has a symptom: the first being whether to seek medical attention, and the second being when the GP decides whether to refer or not. Thus, only 41% of patients with rectal bleeding report it to their doctor. Most symptoms that could represent cancer are not reported to primary care, as the patient makes the - usually correct - assessment that there is a simple explanation for their symptom, and one which does not require medical attention. There is reasonable evidence that patients can identify which symptoms matter. 11 – 12 At the time, however, it may be far from obvious to the clinician that the symptoms represent a malignancy. In retrospect, it is usually easy for the patient to pinpoint when their symptoms began and when they were first reported to primary care. 7 – 10 For the rest of this review, I concentrate upon activity between B and D, so from first presentation to referral for definitive investigation and take most of my examples from the four commonest cancers, breast, prostate, lung, and colorectal. Intervals used in the literature of diagnostic delays.Īlmost all research has examined the whole interval A–E, with only a few studies teasing out where delays are occurring, and where there is the most potential for improvement. 6 However, this headline figure conflates several separate aspects of diagnosis, illustrated in Figure 1. 5 The current estimate is that 7500–10 000 lives are lost each year in the UK from late diagnosis. Even so, the UK's record in cancer mortality remains poor compared with other countries, 4 and it is argued that all these new facilities have made little or no difference. 3 Access to primary care imaging has improved, both in terms of availability and timeliness. Selection of patients is guided by national recommendations, 2 although these are frequently ignored. In the UK, rapid investigation clinics, which offer specialist investigation within 2 weeks, are well established. In theory, cancer diagnosis should have become easier in the last decade. What is irksome to GPs is that they are judged almost entirely on their diagnostic performance in those patients who transpire to have cancer, while given little or no credit for their performance in those who do not. Thus GPs rapidly become highly experienced in diagnosing what is not cancer, and slowly become experienced in diagnosing what is cancer. 1 Although dealing with new cancer diagnoses is relatively rare, (a full-time UK GP will have a new cancer diagnosed in one of his or her patients each month) dealing with the possibility of cancer is an everyday occurrence. Most of those with cancer present with symptoms, and most of these presentations are to primary care. This figure is rising, as competing causes of death diminish in importance. Around a quarter of those who live in the developed world will die of cancer.
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