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The challenges of early diagnosis of cancer in general practice

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Managing missed opportunities when most cancer symptoms are only weakly predictive

The incidence of cancer in Australia is rising due to an ageing population and increased detection of certain cancers through screening. In 2012, an estimated 120 000 Australians were diagnosed with cancer, not counting basal and squamous cell skin cancers.1 Most cancers present symptomatically, even those for which there are national screening programs. In Australia, and other countries with strong primary health care systems, 75%–85% of cancers first present in general practice as a result of symptoms. General practitioners therefore play a key role in the early detection of cancer.2

Delayed diagnoses

Intuitively, diagnosing cancer early should be beneficial. Indeed, perception of a missed diagnosis of cancer is a leading cause of medicolegal complaints in primary and ambulatory care, on the assumption that harm occurred as a result of diagnostic delay.3 There is ongoing debate about the value of early cancer detection in asymptomatic populations through screening tests. At the same time, proving that earlier detection of symptomatic cancer “matters” is also epidemiologically challenging. The waiting time paradox describes the phenomenon in which patients with late-stage cancers present with severe symptoms and are therefore…