Cancer symptoms often missed by GPs in England, study suggests

Analysis of 4,637 people diagnosed in A&E in 2010 finds 41% had visited GP three or more times with possible signs of cancer

Thousands of people diagnosed with cancer in A&E every year have visited their GP three times or more with symptoms, research has shown.

The study found that 71% of all patients diagnosed in accident and emergency departments had seen their GP at least once with symptoms that turned out to be cancer. The remainder had never visited their GP.

Of the group that did see their GP with symptoms, 41% had sought help three or more times while 59% had seen their GP once or twice.

Some of these had difficult-to-spot cancers, such as lung cancer or multiple myeloma, and tended to be younger or female.

But the group also included people with common cancers such as breast cancer. The study found that 31% of patients with breast cancer had visited their GP three or more times, 41% with bowel cancer had visited three or more times, and 37% with prostate cancer had visited three or more times.

People who are diagnosed with cancer as an emergency have a worse prognosis than those diagnosed at an earlier stage. The quicker a cancer patient can get a diagnosis, the better their options for treatment.

The study, said to be the most comprehensive to date, was published in the British Journal of General Practice. The authors, including from University College London, the University of Cambridge and Public Health England, analysed 2010 data from 4,637 people diagnosed in A&E.

They found those patients who had never been to their GP tended to be older, male and living in the most deprived regions of England.

Patients in A&E diagnosed with common cancers who had visited their GP three times or more may be presenting with atypical symptoms, the authors said.

A previous study, including by three of the same authors, found those patients who saw a GP three or more times before being referred for cancer tests were more likely to be dissatisfied with their overall care.

They also have less confidence in the doctors and nurses who go on to treat them, that study found.

Dr Georgios Lyratzopoulos, one of the lead researchers based at UCL, said: “These findings tell us that some patients diagnosed as an emergency might not be acting on ‘red flag’ symptoms which could have prompted them to visit their GP.

“There’s also a host of other factors that may be at play. For example, many elderly patients may find it difficult to get to the surgery or have other conditions which would prevent them from seeking an appointment, such as dementia.

“This highlights the need to explore all the reasons why cancers are diagnosed late, including what happens outside GP surgeries.

“It also shows that late diagnosis is more complex than it’s often presented to be, as there are multiple reasons why cancers are spotted late.”

Dr Julie Sharp of Cancer Research UK said: “Campaigns like Be Clear on Cancerhave boosted the public’s awareness of cancer signs and symptoms. But this study shows that there are multiple reasons that affect how and when a cancer diagnosis is made.

“We need to continue to increase awareness of cancer signs and symptoms and help break down the barriers preventing people from seeing their GP earlier. GPsneed better access to the right tests and referral routes if we want to see this number reduced.”

Judith Brodie, acting chief executive of the charity Beating Bowel Cancer, said: “It’s concerning that the study shows 41% of bowel cancer patients who are diagnosed as emergencies had previously sought help from their GP three or more times.

“A bowel cancer patient’s chance of being successfully treated drops dramatically if they are not diagnosed until a late stage so more must be done to ensure that the public is aware of the symptoms and how important it is to get them checked out as soon as possible.

“Knowledge of the disease will also give them the confidence to persevere with their GP if they feel their symptoms are not being taken seriously enough.”

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