The authors of this quantitative analysis examined data from patients participating in the 2010 National Cancer Patient Survey in England. They included data from 41,299 patients with 24 different cancers and analysed the variation in the number of general practitioner and patient consultations before hospital referral to diagnose cancer. Types of cancer and sociodemographic factors were also considered. The results found (from source):

• Wide variation between cancer types in the proportion of patients who had visited their general practitioner three or more times before hospital referral (7.4% [625 of 8408] for breast cancer and 10.1% [113 of 1124] for melanoma; 41.3% [193 of 467] for pancreatic cancer and 50.6% [939 of 1854] for multiple myeloma).

• In multivariable analysis, with patients with rectal cancer as the reference group, those with subsequent diagnosis of multiple myeloma (odds ratio [OR] 3.42, 95% CI 3.01-3.90), pancreatic cancer (2.35, 1.91-2.88), stomach cancer (1.96, 1.65-2.34), and lung cancer (1.68, 1.48-1.90) were more likely to have had three or more pre-referral consultations; conversely patients with subsequent diagnosis of breast cancer (0.19; 0.17-0.22), melanoma (0.34, 0.27-0.43), testicular cancer (0.47, 0.33-0.67), and endometrial cancer (0.59, 0.49-0.71) were more likely to have been referred to hospital after only one or two consultations.

• The probability of three or more pre-referral consultations was greater in young patients (OR for patients aged 16-24 years vs 65-74 years 2.12, 95% CI 1.63-2.75; p<0.0001), those from ethnic minorities (OR for Asian vs white 1.73, 1.45-2.08; p<0.0001; OR for black vs white 1.83, 1.51-2.23; p<0.0001), and women (OR for women vs men 1.28, 1.21-1.36; p<0.0001).

• The authors identified strong evidence of interactions between cancer type and age group and sex (p<0.0001 for both), and between age and ethnicity (p=0.0013).

• The model including these interactions showed a particularly strong sex effect for bladder cancer (OR for women vs men 2.31, 95% CI 1.98-2.69) and no apparent ethnic group differences in young patients aged 16-24 years, whilst the only cancers without an apparent age gradient were testicular cancer and mesothelioma.

The authors conclude, “Our findings could help to prioritise and stratify early diagnosis initiatives and research, focusing on patients with cancers and sociodemographic characteristics with the largest potential for improvement.”

A related Comment article discusses the results of the analysis and the author writes, “These findings raise several questions. Do modes of cancer presentation vary systematically between different groups of patients? Are general practitioners more reluctant to refer young or non-white patients for investigation of possible cancer? Are participants in these groups less willing to accept a referral to investigate possible cancer?” He adds that the study “will raise concerns for those involved in diagnosing and treating patients with cancer. This descriptive study suggests several hypotheses concerning pathways to accessing cancer care that deserve to be tested prospectively in future research.”

Note: Abstract only available at time of writing.