Britain is still far too slow in spotting cancer early

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The Independent Online

Everyone dreads a diagnosis of cancer - and that is where our problems start. In the public's mind, a dread diagnosis ought to be an easy diagnosis - but that is wrong on both counts. Cancer is not necessarily a death sentence - increasingly it is becoming a disease in the company of which people live out normal lives. And cancer rarely glares at doctors across the surgery desk. Detecting the lump, the shadow, the changed appearance that indicates malignancy is the harder part of the diagnostician's art.

Everyone dreads a diagnosis of cancer - and that is where our problems start. In the public's mind, a dread diagnosis ought to be an easy diagnosis - but that is wrong on both counts. Cancer is not necessarily a death sentence - increasingly it is becoming a disease in the company of which people live out normal lives. And cancer rarely glares at doctors across the surgery desk. Detecting the lump, the shadow, the changed appearance that indicates malignancy is the harder part of the diagnostician's art.

So before we leap to condemn the doctors implicated in the latest spate of cases of alleged mis-diagnoses some careful investigation is required. Did they conduct proper examinations, did they carry out the tests that could reasonably be expected, did they interpret what they found correctly? Despite the best efforts, some cases of cancer will inevitably be missed.

That said, however, Britain's record on cancer is poor by European standards. Although there are worries about the accuracy of the figures and whether like is being compared with like, a consensus is growing that an important reason for our poor showing is that by the time patients in Britain get treatment, their disease is more advanced, and hence harder to treat, than on the Continent. Whether this is because we are slower to go to the doctor with a lump or bump, or whether it is because our GPs are worse at spotting suspect cases and slower to refer, is unclear. None the less, a key deficiency in cancer care appears to exist at this early stage of the process.

Ministers have sought to address the problem by introducing a tough new two-week limit for referrals of suspect cases for a specialist opinion. Clearly this is of benefit if it galvanises slack GPs to get referral letters off promptly, and reluctant specialists to streamline their clinics.

But some doctors have protested loudly that the only effect of the strategy will be to squander resources on reassuring the worried but healthy, rather than providing accurate diagnoses to those at high risk. If specialist clinics become clogged with patients who do not need to be there, it is the high-risk patients who will lose out.

GPs who see one case of breast cancer every three years, and a case of bowel cancer every five, cannot be expected to get the diagnosis right every time. But better education and clear protocols for referral can reduce their chances of getting it wrong. We do not need more patients referred, but the right patients referred.

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