New research from Sahlgrenska Academy at the University of Gothenburg, Sweden, indicates that considerably more cases of suspected cancer can be identified early within primary care.
The thesis of Dr Marcela Ewing, specialist in general medicine and oncology at the Institute of Medicine, is based on information on 4,500 adult patients who were seeking primary in the Vastra Gotaland region, Sweden, and were diagnosed with one of the most common forms of cancer.
This group was then compared to around 18,000 gender- and age-matched control patients at the same health centres, who had no known evidence of having the disease.
Ewing said: “When patients seek care more frequently, as opposed to previously when they maybe just came in to check their blood pressure, it could be a sign that something else is wrong, even if the symptoms can be initially interpreted as benign.”
The difficulties of diagnosis
With over half of those seeking primary care with different complaints the year before receiving a cancer diagnosis, it took four or more doctor visits at the health centre before the diagnosis was made.
There were a substantial number of symptoms that patients sought help for which turned out to be associated with cancer and were presented as early as in the first two consultations. However, patients had to visit primary care doctors at least twice more.
Ewing commented: “Cancer and cancer diagnosis are difficult, and it is something very unusual in the everyday work of a general practitioner. In a year, a general practitioner may only diagnose four or five cases. But you can increase attentiveness and ask yourself more often whether or not it is cancer, especially if the patient returns many times.”
A combination of symptoms
She added: “The value of a single symptom is often insignificant. If you seek primary care for bleeding bowels, the risk is approximately 4% that it is cancer and 96% that it is haemorrhoids or something else that is treatable.
“What we have shown is that it is the combination of symptoms that is important, even if they do not appear at exactly the same time, and attention must be focused on this. If we can identify cancer at an earlier stage, the patient’s prognosis is better, and less of society’s resources are required.”
The seriousness of late diagnosis
Ewing concluded: “A cancer diagnosis is made at a hospital, but it is often the general practitioners that introduce the idea and start an investigation.
“They are key people and it is important that they stay on their toes. The thought of cancer should always be in the back of your mind since the consequences of a late diagnosis can be so serious.”
Source: University of Gothenburg
