GPs warned over failure to diagnose cancers

Patients are dying of cancer because GPs are failing to identify their symptoms, the government's top cancer expert has warned. Professor Mike Richards said botched diagnoses were now 'a significant concern'. ( Guardian )

In an interview with The Observer, Richards, national cancer director at the Department of Health, warned about the consequences of these mistakes. 'Ultimately it can mean that the cancer has progressed to a stage where it can't be cured,' he said. Failed diagnoses also meant that, when cancers were eventually spotted, particularly aggressive treatments, such as chemotherapy or surgery, had to be used. 'That could be a mastectomy rather than perhaps a breast conserving operation,' he said.

The government's recent Cancer Reform Strategy identified late diagnosis as a major reason why the UK has poorer survival rates than some other countries in Europe. Although the cancer death rate is falling, it killed 153,491 Britons in 2005.

'There are 250,000 new patients with cancer every year,' said Richards. 'It's probably only a small proportion who experience a missed or delayed diagnosis. It's a small minority of patients overall. But it's not a negligible figure. We want to reduce this to the smallest possible number.'

Cancer in children and breast cancer were especially hard to diagnose, he said. 'There will be a significant number of women with breast cancer where this may happen, especially where cancer is uncommon, for example women under 50 and even under 40. This can happen among that group. It can happen with any cancer.'

There are no official annual statistics on the scale of the problem. But an unpublished joint study by the Health Department and the National Patient Safety Agency, which investigated records involving missed or late diagnoses of cancer patients from January 2004 to November 2006, showed:

More than 1,900 patients - 55 a month - suffered a missed or late diagnosis, though officials admitted the problem was probably much greater;

Patients waited for periods between a day and 23 months to have their condition confirmed because of diagnostic errors, often at their GP's surgery;

Breast, bowel and lung cancer were the likeliest to involve a botched diagnoses;

Blunders in hospitals added to delays in cancers being identified. These include X-rays, biopsies or blood tests misfiled or misread.

'This is an important issue because in some cases things are going wrong,' said Ben Thomas of the Patient Safety Agency. 'Nobody wants this to happen. Nobody wants to miss a diagnosis or have a late diagnosis. But it does happen. This could happen to anyone. Unfortunately people suffer and people die. We think that practitioner delay, where someone turns up at the GP with symptoms but there's a delay in the GP referring the patient to a specialist, is fairly common.'

Richards said some GPs felt they could not refer patients for tests as often as they would like in case hospitals became overloaded. 'Many patients are referred the first time they go to their GP. But some will go three, four, or even more times,' he said.

Richards's comments come as cancer charities warn that some GPs are wrongly telling sufferers they have other, less serious conditions, such as irritable bowel syndrome, haemorrhoids or gastroenteritis, and send them away with tablets. Similarly some patients in their twenties, thirties and forties are being misadvised by their GP that they are too young to have breast or bowel cancer, which mainly affects the over-50s, despite early signs of the disease.

Cancer experts agree it can be hard for GPs to identify correctly the signs of the disease, partly because the symptoms of certain cancers are also those associated with many other illnesses. A typical GP with a list of 1,800 patients will only see eight or nine new cancer patients every year, and there are about 200 different types of cancer.

'Cancer is difficult to identify and GPs sometimes get it wrong,' said Dr Steve Field, a Birmingham GP and the chairman of the Royal College of General Practitioners. Many of the signs of cancer, such as tiredness, weight loss and rectal bleeding, are also associated with many other conditions, making diagnosis difficult, Field said.

GPs sometimes did not glean enough information about a patient's health from their case history or physical examination to indicate if it is cancer, and some feel they need to see a patient several times before forming a judgment on what was wrong with them, he said.

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