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Durham University News

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GPs spot eighty per cent of cancers after two visits

(8 February 2013)

Professor Greg Rubin

More than eighty per cent of cancers diagnosed by GPs are spotted in the first two consultations, with more than half being referred to see a specialist at the first appointment, according to a new study by a team of scientists including Durham University.

The research, published in the British Journal of Cancer today (Friday), looked at data from over 13,000 patients in order to measure the promptness of cancer diagnosis in primary care. They found that 82 per cent of people were referred after two visits, with over half of patients (58 per cent) referred to a specialist after the first visit.

The study, by Durham, Cambridge and Bangor universities, has also revealed that some cancers are proving harder to spot in the first few consultations, such as lung cancer and myeloma. This may be because they often produce symptoms that are common and not unique to cancer, so can be mistaken for less serious conditions.

The findings show that, the more consultations a patient needs, the greater number of weeks between first presentation and referral. With most of the patients who have these harder-to-spot cancers, it takes longer before there is a suspicion of cancer and they are seen by hospital specialists.

Last year, the Royal College of General Practitioners, in partnership with Cancer Research UK, launched a five-year programme to improve early diagnosis of cancer in general practice, and appointed Durham University’s Greg Rubin as the first ever Clinical Lead for Cancer.*

Co-author Greg Rubin, professor of general practice and primary care in the School of Medicine, Pharmacy and Health said: “We’ve found that most patients who go to their GP with cancer symptoms are being promptly referred to a specialist. NICE referral guidelines have helped people with classic symptoms to be seen more quickly but, for patients with less typical symptoms, the decision to refer isn’t always as simple.

“Reducing the number of pre-referral consultations can result in a more timely diagnosis of cancer. We need to consider ways of making the process of primary care assessment even smarter, for instance by wider use of clinical decision support tools or more efficient investigation pathways.”

Dr Georgios Lyratzopoulos, study author and National Institute for Health Research (NIHR) post-doctoral research fellow working at the Cambridge Centre for Health Services Research, said: “These results show the progress we’re making in spotting cancer at the earliest opportunity. We now understand the typical symptoms of some cancers, like breast and melanoma, very well and that helps doctors to spot them quickly.

“Other cancers have less typical symptoms, making them more difficult to recognise straight away. Not suspecting cancer early enough can be stressful for patients and their relatives so understanding the symptoms of these cancers better is where we need to be making greater research efforts to help spot the disease earlier.”

Sara Hiom, early diagnosis director at Cancer Research UK, said: “These findings highlight the progress we’re making, as well as the areas that need to be improved. Cancer can be treated more effectively when diagnosed early, so it’s essential that GPs know what to look out for and have the necessary resources to get cancers consistently diagnosed more quickly and accurately.

“But it’s also important that we all act on any persistent health changes that concern us and have the confidence to go back to our GPs if problems don’t clear up after an initial visit.”

*The Clinical Lead for Cancer position is the first of its kind and is jointly funded by the RCGP and Cancer Research UK. It recognises the vital role GPs play in the early diagnosis of cancer and throughout a patient's treatment within the health system.

For more information on some of the most common cancer symptoms, please visit: http://www.cancerresearchuk.org/cancer-info/spotcancerearly/cancersignandsymptoms/keysignsandsymptoms/

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