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I read with astonishment the article on cancer diagnosis in primary care (News, January 29). Gerry Steinberg MP is talking absolute nonsense. He should provide evidence to support what he claims or withdraw his accusation against GPs.

What Mr Steinberg and the Committee of Public Accounts should realise is that it is difficult to diagnose cancer in cases where it is not obvious. The guidelines help in the process but many patients do not fit guidelines.

General practice deals with uncertainty and with sypmtomatology that is evolving. To be able to diagnose or suspect cancer on the first day a patient presents is not possible except in those with symptoms and signs suggestive of cancer.

Additionally, Mr Steinberg and the public need to realise that every symptom in medicine could also be a symptom of cancer.

Guidelines are there to assist in the recognition of patterns of disease which may indicate cancer in some but not in all cases. To refer all patients on the first day they present would be as ridiculous as it would be unhelpful.

Fortunately most people realise this point of view when it is discussed with them.

In a recent presentation by me at WONCA in Orlando looking at cancer diagnosis in the practice over 20 years, it was found that 29 per cent of cancer diagnoses did not fit the available guidelines when applied retrospectively.

Ten per cent of cancers were incidental findings,

5 per cent were detected by screening and 12 per cent had unusual features.

Dr NK Menon

Ongar, Essex

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