Which cancers are more difficult to suspect in primary care?

Back in 2012 members of our team reported the proportion of multiple (three or more) pre-referral consultations for 24 cancer diagnoses (1). This previous work provided evidence of the variability in the diagnostic difficulty of different cancers in primary care, reflecting the cancer’s ‘symptom signature’. This work used patient self-reported data from one year of the Cancer Patient Experience Survey (2010) and due to sample size restrictions only 24 of the common cancers were reported.

In our new paper in BJGP we have extended this inquiry to 12 rarer cancers without published evidence by pooling together data from three years of the survey (2). We found that patients with small intestine, bone or soft-tissue sarcoma, liver, gallbladder, cancer of unknown primary and ureteric cancers had higher than average (i.e. >30%) frequency of multiple pre-referral consultations. Previous data indicated that the ‘harder-to-suspect’ cancer was multiple myeloma but here we found that patients with small intestine had an even higher proportion of multiple consultations (60%).

We hope this piece of work will raise awareness of the challenge in appropriately suspecting the diagnosis of cancer in primary care and to provide the evidence necessary to support research and initiatives to improve the timeliness of diagnosis (for example point-of-care biomarker-based tests).


(1) Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, Abel GA. Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. The Lancet oncology. 2012;13(4):353-65.

(2) Mendonca SC, Abel GA, Lyratzopoulos G. Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data. Br J Gen Pract. 2016 DOI: 10.3399/bjgp16X683977

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