Professor Mike Richards, national clinical director for cancer, is about as wrong as it is possible to be on cancer diagnosis (Cancer awareness campaigns are essential to tackle late diagnosis).
He says ‘there is broad agreement... that late diagnosis is a major factor in differences in cancer survival between countries'. In fact, there is little evidence for this and our experience as GPs suggests that it is unlikely. Cancers are a heterogeneous group of diseases and one cannot simply compare different countries' cancers as if they were brands of car.
Most GPs' experience is that some patients have aggressive cancers with short histories that are incurable from the word ‘go', while others are very treatable.
Other cancers still, including many found by screening, are not really life-threatening at all, but diagnosing them – causing nothing but distress and danger to the patient – does wonders for statistical measures of survival rates. Surely we have learned to be wary of epidemiological associations, which time and again have been shown to be just that – association, not causation?
Professor Richards should be testing the hypothesis – because that is all it is. Cancer awareness campaigns are great for raising money for charities and boosting the profile of back-room generals like Professor Richards, but do a lot of harm to the rest of us. The harm comes from raising anxieties, increasing the burden of dealing with the ‘worried well' that keeps us away from genuinely suffering patients, and above all from reducing morale among GPs.
There is much that Professor Richards could be doing to improve care for patients with cancer – for example, the biggest problem for my patients is a long wait from initial diagnosis to treatment plan. But nagging GPs and patients is not the way to do it.
From Dr Ted Willis, Brigg, Lincolnshire
