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The challenge for GPs: potential early cancer diagnosis vs over testing

The challenge for GPs: potential early cancer diagnosis vs over testing - Featured Image

General Practitioners face a balancing act when trying to trying to rule out an early cancer diagnosis in their patients.

Professor Jon Emery, the Herman Professor of Primary Care Cancer Research at the University of Melbourne wrote in the Medical Journal of Australia that GPs might only see 5-10 cases of non-cutaneous cancer each year among their several thousand consultations.

As a result, “even red-flag cancer symptoms have low positive predictive values”, he wrote.

“Only a few symptoms, such as [coughing up blood], breast lump and [blood in the urine], have a greater than 5% chance of being due to cancer in primary care. Most symptoms of cancer have more common benign causes in general practice. Further, cancers in general practice often present initially with more subtle non-specific symptoms.”

He said GPs are faced with the pressure of over-investigating patients who are unlikely to have cancer and the resultant costs to the patient and the health care system.

Related: Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study 

GPs also have limited access to key tests which leads them to order less appropriate ones.

There are a new range of risk assessment tools (RATs) such as the charts developed by Hamilton and colleagues and the QCancer model for men and women of Hippisley-Cox and Coupland.

However Professor Emery said  “there is limited evidence on how GPs will use such tools or what impact they will have on diagnostic decision making”.

Read the full article in Medical Journal of Australia

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