Late presentation, late diagnosis, late stage diagnosis, delayed diagnosis, delayed presentation: terminology confuses the message in UK cancer policy

In his discussion of the use of terminology related to cancer diagnosis, Matthew Day again repeats the idea that the number of visits to a GP somehow is related to diagnostic delays. He says, "The figures also tell us that one in three patients was not initially referred for a hospital appointment, with one in five seeing their general practitioner three or more times before a referral was made."

I cannot understand why this is seen as a problem. Apart from those presenting to Emergency Departments with acute problems such as heavy bleeding or bowel obstruction, all cancer patients in the UK have to be referred to secondary care by their GPs. The above statement should be read as showing that in two thirds of cancer diagnosis, the initial consultation results in a referral. In many cases, there is insufficient evidence from the history and examination to allow the GP to make the referral. Laboratory tests and imaging help to confirm or deny the suspicions. This requires at least one more visit to the practice to have blood taken, and a further consultation with the GP for the results. Thus three visits are required to complete the picture. For many malignancies, review after a period of time to re-examine the patient or for the symptoms to evolve so they are clearer is prudent and indeed it is the persistence of symptoms or failure to respond to simple treatment that clinches the diagnosis.

It is time that GPs stop being considered as part of the problem of delay in cancer diagnosis, and become lauded for the excellent work they do in spotting two thirds of cancers at the first presentation and four out of five within three clinical contacts.