Approaches to diagnosing cancer earlier in general practice

In the UK there have been significant efforts over the last two decades to reduce delays in cancer diagnosis in response to the nation's poorer survival outcomes compared to other high-income countries.Cancer screening programmes are one approach to improve survival through early detection, but the majority of cancers are detected following symptomatic presentation in primary care.Theoretical models of diagnostic delay emphasise the importance of considering patient, health system, and tumour factors along a pathway from symptom appraisal and help seeking to diagnostic assessment and treatment. 1Such models identify potential points of intervention to improve the timeliness of cancer diagnosis. SYMPTOM AWARENESS INTERVENTIONSImproving community symptom awareness and reducing barriers to early help seeking is one such approach.Several symptom awareness campaigns have occurred in the UK with some evidence, from before-and-after data, of positive effects on presentations to health care, cancer diagnoses, and earlier stage. 2In contrast, a controlled trial of a community symptom awareness intervention in rural Australia failed to demonstrate reduced time to presentation in people subsequently diagnosed with cancer. 3There remains some doubt about the effectiveness and cost-effectiveness of community awareness campaigns; they are relatively expensive and may not reach those most at risk of poorer cancer outcomes.In this issue, Laake et al report a more targeted approach in patients at risk of later diagnosis based on socioeconomic status and past consulting behaviours. 4They trialled a letter from their general practice that highlighted six 'red-flag' cancer symptoms and promoted help seeking.