Abstract
The recent publication of the coalition government's refreshed Strategy for Cancer1 has restated the importance of earlier diagnosis as the key to improved outcomes. As it does so, it is joined by a number of other countries in Europe and farther afield, not least the US.2 General practice is identified as being a key player in this strategy, but it begs the question: what contributions can general practice make to improving cancer outcomes? The Cancer Reform Strategy in 2007 brought a new focus on earlier diagnosis of cancer. It resulted in the National Awareness and Early Diagnosis Initiative, a programme of work intended to achieve earlier presentation of people with symptoms, to optimise clinical practice and healthcare systems, and to improve GP access to diagnostics. This includes a National Audit of Cancer Diagnosis in Primary Care, led by the Royal College of General Practitioners with the support of the National Cancer Action Team and the Department of Health's Cancer Policy Team. In the past 2 years they have produced audit and significant event analysis toolkits and have overseen their widespread use by practices, primary care trusts, and cancer networks.3 Every practice in England is currently being offered its cancer profile: a set of 25 measures of performance in cancer screening and diagnosis. Elsewhere in Europe, early diagnosis initiatives include the introduction in Denmark of a fast-track system for alarm symptoms, but systematic initiatives addressing public awareness or primary care performance are still rare. The view that earlier diagnosis of cancer leads to improved outcomes, including survival, is intuitively credible — the same logic lies behind cancer screening — but it is remarkably difficult to confirm. This is due to differences in definitions and measurement of delay and outcome, together with a lack of high-quality statistical models to account …
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