Diagnosing cancer early is important for improving the chances of long-term survival from the disease. Perceived delays in cancer diagnosis are a common cause of distress for patients and their families – and a frequent source of legal complaints.
Most patients with cancer first present with symptoms to their GP, and so the GP plays a critical role in early cancer diagnosis. But this is a challenging task, and as our new paper in the Medical Journal of Australia shows, it is even more challenging for certain cancers.
As part of a patient experience survey of more than 1,500 patients attending a Victorian cancer hospital, we examined patients’ visits to their GP and time taken to see a cancer specialist preceding their cancer diagnosis.
We showed that people with myeloma (cancer of the plasma cells in bone marrow), pancreatic or brain cancers were more likely to have had multiple visits to their GP before referral for suspected cancer.
In contrast, women with breast cancer were often referred after the first GP visit and were most likely to be diagnosed within three months of the onset of their symptoms.
Watch: How well do you know the warning signs of bowel cancer? Post continues after video.
There are some important reasons why diagnosing pancreatic, brain tumours and myeloma are the most challenging for GPs.
Symptoms more likely something else.
These are all relatively rare cancers and so a GP might only see a patient with each of these cancers once every three to five years. More importantly, the symptoms with which these cancers first present are usually caused by a much more common, benign condition.
For example, pancreatic cancer may initially cause abdominal or back pain, indigestion, or reduced appetite. Only later may people develop jaundice, which is a much more serious and specific symptom of pancreatic cancer, but one that’s usually associated with later-stage disease.
Brain cancers usually first present with a headache and only rarely with more specific symptoms such as muscle weakness or a seizure. Myeloma also has non-specific symptoms such as fatigue, back pain and more frequent infections. (Post continues after gallery.)
The first time someone visits their GP with indigestion, for example, the doctor is unlikely to consider pancreatic cancer as a likely cause for their symptoms because it is so unlikely (less than a one in 100 chance). Even if that patient had also lost weight, the likelihood it is due to pancreatic cancer is still only about one in 25.
To add to the complexity, a GP may be more likely to consider stomach rather than pancreatic cancer because it is a more common cancer causing this symptom. A GP may therefore refer this patient for an endoscopy to check for stomach cancer instead of a CT scan, the preferred initial test needed to diagnose pancreatic cancer, thereby delaying diagnosis.