Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers

Background: It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk fac...

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Bibliographic Details
Published in:British journal of cancer 2009-12, Vol.101 (S2), p.S92-S101
Main Authors: Macleod, U, Mitchell, E D, Burgess, C, Macdonald, S, Ramirez, A J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Biomedical and Life Sciences
Biomedicine
Breast cancer
Cancer Research
Comorbidity
Delayed Diagnosis
Drug Resistance
Epidemiology
Female
full-paper
Gynecology
Humans
Male
Medical referrals
Medical research
Middle Aged
Molecular Medicine
Neoplasms - diagnosis
Neoplasms - ethnology
Neoplasms - psychology
Oncology
Patients
Primary care
Qualitative Research
Referral and Consultation
Risk Factors
Socioeconomic Factors
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Summary:Background: It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation. Methods: We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these. Results: Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results. Conclusion: Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately.
ISSN:0007-0920
1532-1827
DOI:10.1038/sj.bjc.6605398