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Delayed cancer diagnoses reported for minorities and young people

Robin Wulffson MD's picture
cancer diagnosis, delayed diagnosis, female, young, ethnic minority

CAMBRIDGE, ENGLAND - A new study has reported that if you are stricken with cancer, you are more likely to receive a prompt diagnosis if you are an older Caucasian. It reported that the number of visits to a primary care physician was higher before a cancer patient was referred to a specialist if the individual was young, an ethnic minority, a female, or was stricken with a less common form of cancer.

Researchers at the University of Cambridge published their findings on February 24 in the journal The Lancet Oncology. They reported that 77% of cancer patients who first present to their primary care physician (i.e., a general practitioner or family physician) with suspicious symptoms are referred to a specialist after only one or two visits; however, they also noted that a wide variation was found in the number of times a cancer patient visited a primary care physician before they were referred to a specialist, with the most pre-referral visits occurring when the cancer was one of the less common types, or when the patient was either female, young, or an older person from an ethnic minority.

The researchers surveyed more than 41,000 cancer patients in a secondary analysis of the English National Cancer Patient Experience Survey conducted on patients with 24 different cancers in 2010. Although the research was specific to physicians and hospitals in the United Kingdom, clinical senior research associate Georgis Lyratzopoulos noted that he was certain that the trends, which were discovered, will be comparable to future research conducted in the United States and elsewhere.

The investigators found that patients with breast cancers, melanomas, testicular cancers, and endometrial cancers were more likely to be referred to a specialist after just one or two consultations. In contrast, however, patients with some less common cancers such as multiple myeloma, pancreatic cancer, stomach cancer, ovarian cancer, lung cancer, colon cancer, and lymphoma were more likely to require three or more visits to their primary care physician before they were referred to a specialist. For example, patients with multiple myeloma, which is much more difficult to diagnose because it mimics many other conditions, were 18 times more likely to require three or more pre-referral consultations compared with patients with breast cancer.

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Dr. Lyratzopoulos said, “The bottom line is we need to prioritize research on the diagnosis of cancer… We’re highlighting the limitations of the cancer research model. What has been forgotten implicitly is research to develop the better understanding of how people with cancer present: what is called ‘symptom signature.’”

The researchers also reported that the diagnosis of cancer was more challenging among women, young patients, and older ethnic minority patients. The reason for this discrepancy was that these individuals are known to have a lower risk of developing cancer compared with older, male, and Caucasian patients in the United Kingdom.

The researchers offered some possible explanations regarding why some of the patient groups were less likely to receive a prompt referral:

  • As differences in ethnic minorities were only found for older patients, this indicates that communication difficulties may be responsible.
  • Women with bladder cancer were found to be more than twice as likely as men to visit their primary care physician three or more times before given a referral. This may be due to a difficulty in discerning between the signs of bladder cancer from those of benign gynecological conditions or bladder infections.
  • Inasmuch as young people have a lower rate of cancer, the researchers noted that primary care physicians were likely to consider a benign condition rather than cancer.

The researcher recommended that physicians and other healthcare professionals should be made aware of these discrepancies; in so doing they would be less likely to overlook the possibility of cancer in low risk individuals or not consider one of the rarer cancer diagnoses. They stressed that it was of utmost importance to shorten the diagnostic process as much as possible, because the earlier the diagnosis is made, the better chances for the patient’s survival. Dr. Lyratzopoulos said, “We need to move away from the idea that we just need to treat cancer better. While treating cancer is important, prompt diagnosis can make treatment just as effective.”

Reference: The Lancet Oncology