Detecting cancer early
One of the main targets of modern medicine is to detect serious disease early, as usually the sooner treatment is initiated the more effective it is and the better the patient's outcome. All of us can buy into this idea and a lot of resources have been invested to achieve this target. Cancer in particular is usually associated with a poorer prognosis if picked up late and ideally should be detected as early as possible in its natural history.
Although we now have some established screening programmes in place, such as cervical smears and breast screening, there is no specific screening method available for most cancers. So the next best step is to educate the public to present early with significant symptoms and signs, and doctors to have a high index of suspicion when dealing with patients who may have cancer.
In primary care, however, it can be very difficult to pick out the serious early signs and symptoms of potential cancer, amid the sea of non-specific presentations that we witness every day. This was reflected by some recent figures reported in a univadis GP News article (click here). The article reports: "Cancer referral rates vary markedly across England, reveal data published today by the National Cancer Intelligence Network." For those of us in the front line that statement comes as no great surprise.
The article adds: "The proportion of referrals that go on to be diagnosed with cancer also varies considerably, from a low of 2.3% in Hammersmith and Fulham to a high of 15.6% in Herefordshire."
Of course, the reasons for such substantial variation are numerous and not easily determined. For example, it could be due to the characteristics of the practice populations, or down to the individual GPs themselves, with some GPs over-referring and others under-referring.
As the article acknowledged, it is not always easy to detect cancer early, but if we can learn something from these data and disseminate good practice then this is to our patients' benefit. Equally the public should receive better information, while referral pathways could be tweaked and optimised. As well as detailed scientific research on the biology of cancer, beating the disease also involves better education of everyone concerned and proper analysis of information that is already out there.
Dr Harry Brown, editor-in-chief Univadis
By Dr Harry Brown