Revealed: GPs failing to spot two thirds of cancers

Two in three cases of cancer are not picked up by GPs, according to research that shows for the first time how long patients really wait for a diagnosis. Researchers said the findings were “worrying” and urged family doctors to be “more proactive” about sending patients for tests, even if symptoms were not clear cut. The study of more than 135,000 patients with two of the most common forms of the disease found average waits of more than eight weeks for diagnosis. The vast majority of cases that turned out to be cancer were never suspected by family doctors, so were not given an urgent referral. Experts warned that the delays were the “difference between life and death” for many patients, fuelling Britain’s poor survival rates. The study by Cancer Research UK found that just 37 per cent of all cancer diagnoses in England involved patients who had been given an urgent referral by their GP, because the disease was suspected. Just 32 per cent of diagnoses for bowel cancer and 28 per cent of diagnoses for lung cancer were identified this way. The study shows that without such a referral, those with bowel cancer wait an average of 61 days for a diagnosis, five weeks longer than the cases that were suspected by GPs. What the study found One in four patients faced a delay of more than three months. Overall, cases that had been classed as “routine” were four times as likely to face a long wait as those given an urgent referral, researchers found. Lung cancer patients had an average wait of 69 days, which was twice as long as the cases that were spotted and given an urgent referral.  One in four waited more than four months after first seeing a doctor, the study, published in Cancer Epidemiology, found. Dr Jodie Moffat, Cancer Research head of early diagnosis, said it was “worrying” to see the high number of patients not diagnosed until they ended up in hospital as an emergency. The study found 35 per cent of lung cancer patients and 24 per cent of bowel cancer patients only received their diagnosis after being rushed to hospital, when symptoms were severe. Dr Moffat said: “Clearly there are patients here for whom a quicker timescale would have meant a different outcome, in terms of survival. We need a system that works for all patients. “One of the things this shows is quite a few cases which came through as an emergency presentation, which is worrying. For some of these patients, it is the difference between life and death.” BBC Middle East Editor Jeremy Bowen has talked about his diagnosis with bowel cancer  Credit: ii Schroer She urged GPs to err on the side of caution if there was a chance of cancer. “We need to encourage and support GPs to be a bit more proactive about thinking who might have cancer, and also in not getting too caught up in stereotypes about who might have particular types of disease, such as not thinking about lung cancer in non-smokers,” she said. “When you look at international research, it shows GPs here tend not to refer patients for tests as those in some other countries [do].” Studies have repeatedly shown that Britain’s cancer survival rates lag behind other countries in Europe, with research showing that given the same symptoms, doctors elsewhere are more likely to refer for tests. Last year, the largest ever global study of cancer survival, published in The Lancet, found the UK fell into the bottom half of the league table, for many common types of the disease. In 2015, the National Institute for Health and Care Excellence published guidance that lowered the threshold for referral, advising GPs to act on any suspicion of cancer, as well as on symptoms that are seen as “red flags”. Dr Moffat said the latest research showed the importance of this. “Even if a patient’s symptoms are not ticking all the boxes, if a GP has got an instinct that something is going on they should be able to refer urgently. If they choose to refer routinely instead, the patient will likely have a longer time to diagnosis, and if it is cancer, for some patients this could make a difference to their chances of a good outcome,” she said. Bowel cancer | Six signs to watch out for The charity found that among 20 types of cancer, one in four patients diagnosed after not being given an urgent referral could expect to wait at least 80 days for diagnosis. Dr Moffat said that GPs sometimes avoided making referrals because they were aware of heavy pressure on services. She raised concerns that NHS pledges to ensure speedier diagnosis for those with suspected cancer could drive even longer times for those who are referred for routine tests. From March next year, patients urgently referred with suspected cancer, or as a result of screening, should receive a diagnosis or the all-clear within 28 days. NHS England said: “This report is right about the benefits of early diagnosis, but it describes the position in 2015, not the situation today. In the four years since this report’s now outdated figures, there has been a huge increase in urgent cancer referrals, with two million cancer checks last year – the highest number on record, and more than double those undertaken in 2010.”