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to identify those patients who might be diagnosed with cancer, even when the presenting feature is regarded as being highly predictive of cancer. Finally, Lyratzopoulos and colleagues study suggests that individual patient characteristics might be associated with general practitioners readiness to refer for cancer investigation. Young patients and ethnic minorities were more likely to have had three or more consultations before referral than older or white patients. These ndings raise several questions. Do modes of cancer presentation vary systematically between dierent 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? Lyratzopoulos and colleagues 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.
Martin Gulliford
Kings College London, Department of Primary Care and Public Health Sciences, London, UK martin.gulliford@kcl.ac.uk
I declare that I have no conicts of interest. 1 Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, Abel GA. Variation in number of general practioner consultations before hospital referral for cancer: ndings from the 2010 National Cancer Patient Experience Survey in England. Lancet Oncol 2012; published online Feb 24. DOI:10.1016/ S1470-2045(12)70041-4. Cancer Research UK. Cancer survival ratestrends. http://info. cancerresearchuk.org/cancerstats/survival/veyear/ (accessed Jan 23, 2012). Coleman MP, Rachet B, Woods LM, et al. Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. Br J Cancer 2004; 90: 136773. Moller H, Linklater KM, Robinson D. A visual summary of the EUROCARE-4 results: a UK perspective. Br J Cancer 2010; 101: S11014. Richards MA. The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. Br J Cancer 2010; 101: S14. Jones R, Latinovic R, Charlton J, Gulliford MC. Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database. BMJ 2007; 334: 1040. Neal RD. Do diagnostic delays in cancer matter? Br J Cancer 2010; 101: S912. Gulliford MC, Petruckevitch A, Burney PG. Survival with bladder cancer, evaluation of delay in treatment, type of surgeon and modality of treatment. BMJ 1991; 303: 43740.
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