Auditing the diagnosis of cancer in primary care: the experience in Scotland

INTRODUCTION: This paper reports on an ongoing primary care audit of cancer referrals undertaken in Scotland in 2006–2007 and 2007–2008. METHODS: General practitioners (GPs) in Scotland were asked to review all new cancer diagnoses within their practice during the preceding year. RESULTS: 4181 patients were identified in year 1 and 12 294 in year 2. The pathway taken for patients to present to, and be referred from, their GP has been analysed for 7430 of the 12 294 patients identified within year 2 across five separate health boards. The time from first symptoms to presentation to a GP varied between tumour types, being the longest (median 30 days) for head and neck cancers and the shortest (median 2 days) for bladder cancer. In all, 25% of patients within the following tumour groups waited longer than 2 months to present to their GP following first symptoms: prostate, colorectal, melanoma and head and neck cancers. Once patients had presented to their GP, those with prostate and lung cancer were referred later (median time 11 days) than those with breast cancer (median time 2 days). The priority with which GPs referred patients varied considerably between tumour groups (breast cancer 77.5% ‘urgent’ compared with prostate cancer 44.7% ‘urgent’). In one health board the proportion of cancer patients being referred urgently increased from 46% to 58% between the first and second audit. CONCLUSION: Our data show that there are very different patterns of presentation and referral for patients with cancer, with some tumour groups being more likely to be associated with a delayed diagnosis than others.