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At the heart of general practice since 1960

Imaging delays hit cancer diagnosis

By Lilian Anekwe

Lack of GP access to key diagnostic tests is delaying detection of cancer in a ‘significant minority' of cases, a major national audit has reported.

As many as one GP in five reported a diagnosis of brain cancer had been delayed by poor access to diagnostics, 18% of GPs said the same was true for cancer of the gall bladder, and 13% with pancreatic cancer.

One GP in seven said inability to quickly refer for ultrasound had led to diagnostic delays for ovarian cancer, as Pulse first reported from initial findings in February. Ultrasound is recommended as a key diagnostic test in draft NICE guidance for GPs on ovarian cancer published last month.

The audit covered one in eight practices in the UK, giving data for more than 18,000 cancers picked up in general practice over six months, including patient demographics, first appointment and referral, symptoms recorded, referral route, and type and stage of cancer at diagnosis.

Nearly half of cancers were diagnosed while still confined to the original organ, a quarter had spread locally and fewer than one in five had metastasised.

But GPs often said access to diagnostics would have allowed diagnoses to be made sooner, particularly citing barriers to access for CT, MRI, chest X-ray and ultrasound.

Dr Cathy Burton, a GP in Lambeth, south London, and Macmillan adviser who worked on the audit, said: ‘Radiologists are very protective of CT scans and don't like GPs to request them often, but it may help where chest X-rays are equivocal. GPs are also saying they want better access to ultrasound - it's surprising many can't access it in a timely way.'

Dr Burton led an analysis of practices in south-east London that took part in the audit, showing avoidable delays occurred in 21% of practices. ‘In a significant minority improved access is likely to speed up diagnosis,' she told delegates at this month's RCGP conference.

The results came as the Department of Health launched general practice profiles on cancer, including information ‘to enable GPs to benchmark their activity and performance against other practices'.

The profiles, which will be made available to the public ‘in due course', will cover GP practices' take-up of cancer screening, use of the two-week pathway, proportion of patients referred urgently and subsequently diagnosed with cancer, endoscopy procedures and emergency presentations and admissions.

DH cancer tsar Professor Mike Richards said: ‘We'd encourage cancer leads to access the profiles. It will enable them to assess variations between GP practices.'

As many as one GP in five reported that poor access to diagnostics has delayed diagnosis Cancer in general practice

• Total cancers diagnosed in audit – 18,113
• Tumours confined to organ – 8,316 (46%)
• Locally spread tumours – 4,557 (25%)
• Tumours with distant metastasis – 3,203 (18%)
• Tumours of unknown stage – 2,037 (11%)

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