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26 April 2017


GPs need access to new and improved diagnostic tools in order to improve detection of cancer, according to a new analysis.

A study found that about 6% of cancer patients are diagnosed as emergencies without seeing a GP at all.

The research examined the history of patients diagnosed with cancer as emergencies - about 20% of the total.

About a third of these had never seen a GP about their symptoms before they became critical - while about 23% had a seen a GP three times or more.

The study in the British Journal of General Practice examined some 4,600 patients with 18 different types of cancer.

The study involved researchers at University College London, Cambridge University, Exeter University and Public Health England and was backed by Cancer Research UK.

The researchers said that some of the patients who undertook multiple GP visits had hard to spot cancers, such as myeloma and lung cancer. This also involved relatively large numbers of patients with non-Hodgkin lymphoma and prostate cancer, the researchers report.

They were also often quite young at an age when development of cancer is rare.

Patients who needed emergency care for cancer without seeing a GP had relatively high rates of brain, renal, endometrial, breast and rectal cancer, the research found.

Researcher Dr Georgios Lyratzopoulos, from UCL, said: ‘These findings tell us that some patients diagnosed as an emergency might not be acting on ‘red flag’ symptoms which could have prompted them to visit their GP. There’s also a host of other factors that may be at play.

‘For example, many elderly patients may find it difficult to get to the surgery or have other conditions which would prevent them from seeking an appointment, such as dementia.

‘This highlights the need to explore all the reasons why cancers are diagnosed late, including what happens outside GP surgeries. It also shows that late diagnosis is more complex than it’s often presented to be, as there are multiple reasons why cancers are spotted late.”

Royal College of GPs chair Professor Helen Stokes-Lampard said: ‘75% of patients found to have cancer are referred after only one or two GP consultations, and in the last five years the proportion of cancers diagnosed as an emergency has dropped from 25% to 20%, and a higher proportion of patients are being diagnosed at an earlier stage of the disease.

‘However, as this study shows, there are still some patients who seem to be missing or ignoring worrying symptoms until they are severe enough to send them to A&E. They are not seeing their family doctor at all, and are instead being diagnosed at a later stage as an emergency, which is known to reduce the chances of a good outcome.’

She added: ‘Family doctors would be helped by increased access to new and improved diagnostic tools to help them identify cancers that are more difficult to spot, and this is something that the RCGP has long been calling for.’

Source: Abel GA. et al. Emergency diagnosis of cancer and previous general practice consultations. British Journal of General Practice 25 April 2017

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