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NICE is urging GPs to be more vigilant in spotting early signs of lung cancer after warning that patients with symptoms such as persistent cough are waiting too long to be investigated.

Any patients with haemoptysis or persistent cough, weight loss and dyspnoea should be referred urgently for X-ray, according to final NICE guidance on lung cancer released this week.

Patients should be referred if symptoms persist for longer than three weeks, the guidance said (see box).

Dr David Bellamy, member of the guidelines development group and a GP in Bourne-mouth, said: 'GPs need to be made more aware of the presenting symptoms of lung cancer so patients can be referred at an early stage.

'Whereas most patients with haemoptysis will be rapidly referred, those with persistent cough or less specific symptoms may wait too long before investigations.'

The guidance came a month after GPs reacted with fury to a report from the MPs' committee of public accounts attacking them for failing to spot early signs of cancer.

But a new report from the National Audit Office shows GPs are becoming increasingly successful at referring cancer patients urgently.

Overall 58 per cent of cancer patients were seen within two weeks of GP referral in 2004 compared with 46 per cent in 2000.

The proportion of lung cancer patients seen within two weeks increased from 49 to 68 per cent.

Four in five cancer patients were positive about the care they had received from their GP.

Dr William Hamilton, clinical research fellow in the department of primary care at the University of Bristol, said criticisms of GPs ignored the fact that lung cancer symptoms were 'terribly common' in the population.

But he said that the new guidance provided 'practical' advice.

Dr David Lyon, PEC chair for Hatton PCT and former cancer lead, worried that chest X-rays were a 'crude test' and could miss cancers.

NICE recommendations

Offer urgent chest X-ray if patient presents with:


·Or any of the following symptoms if unexplained and lasting over three weeks: Cough, chest or shoulder pain, dyspnoea, weight loss, chest signs, hoarseness, finger clubbing, features suggestive of metastasis, signs of cancer in lymph glands or neck

After X-ray

·If chest X-ray or CT scan suggests cancer, refer patients urgently

·If chest X-ray is normal but cancer is strongly suspected, refer urgently anyway

By Emma Wilkinson

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