Are Primary Care Physicians Missing Cancer Symptoms?

Peter Russell

April 26, 2017


Thousands of people diagnosed with cancer in hospital as emergency patients had already visited their GP with symptoms, new figures show.


Among a group of people diagnosed with cancer in an emergency setting, a quarter had seen a GP about their symptoms at least 3 times, according to new research.


However, the study in the British Journal of General Practice found that around a third of people diagnosed with cancer in A&E in England had not seen a doctor beforehand.


Experts say the findings shed new light on why cancer may be diagnosed late, a situation which makes treatment less effective because the disease is usually at a more advanced stage.


Diagnoses of 18 Different Cancers


Researchers from University College London, the University of Cambridge, the University of Exeter and Public Health England analysed data from 4,647 cancer patients, covering 18 different types of cancer, to find out how many times they had seen a GP before the disease was diagnosed as an emergency.


Among these, 29% had not visited a GP before their diagnosis. Men were more likely than women to fit into this category, along with older people and those from more deprived backgrounds.


Among the 71% of people diagnosed as an emergency who had previously seen a GP about their symptoms, 41% had seen their doctor at least 3 times beforehand. These people were more likely to be women, younger people and those from ethnic minorities.


Some Cancers 'Harder to Spot'


The researchers point out that some of these people had cancers that were more difficult to diagnose, such as lung cancer and myeloma, a cancer of plasma cells in the bone marrow.


Also, some people had symptoms at a younger age than might usually be expected, or may have seen their doctor with unusual symptoms that made it harder to diagnose, the researchers say.


The authors conclude: "Contrary to suggestions that emergency presentations represent 'failures of

primary care', the present findings suggest that many emergency presenters have no prior contact with primary care."


They suggest that there may be a range of practical, emotional and health barriers that men, older people and those from deprived backgrounds delay seeking help for cancer symptoms. They suggest there may be scope for health campaigns to raise awareness about cancer symptoms in high risk groups.


Cancer Research UK, which funded the study, said it was important to help break down the barriers preventing people from seeing their GP earlier, while GPs need better access to the right tests and referral routes.


Early Diagnosis 'Taken Seriously by GPS'


Commenting on the study in a statement, Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said: "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.


"GPs take their role in diagnosing cancer as early as possible very seriously and we would urge patients who experience any concerning or persistent symptoms to book an appointment with their GP."



Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data, Abel G et al, British Journal of General Practice

Cancer Research UK

Royal College of General Practitioners (RCGP)