Early diagnosis of cancer in primary care how can we 癌症的早期诊断我们如何才能.pptx

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2017-06-15 发布于上海
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Early diagnosis of cancer in primary care how can we 癌症的早期诊断我们如何才能.pptx

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The challenges of early diagnosis of cancer in primary care Jon Emery Professor of General Practice University of Western Australia Director of PC4 Early cancer diagnosis ‘I went to see my oncologist in hospital earlier this week and we talked about this and that, and the importance of catching cancer early, which I found a bit annoying as they had not caught my cancer early, but it turned out he was just filling in time and wanted to talk to me about something different.’ O Cochrane review of Hemoccult screening on colorectal cancer mortality Symptomatic cancer and early diagnosis Richards et al Lancet 1999 Delays from symptoms to diagnosis of 3-6 months associated with 7% worse 5-year survival from breast cancer Effects not due to lead time bias Longer delays associated with more advanced disease Colorectal cancer diagnostic interval and mortality Torring et al BJC 2010 Waiting list paradox Diagnostic intervals 5 weeks associated with worsening mortality if ‘alarm symptoms’. Similar U-shaped association for lung, melanoma and prostate cancer. Variations in cancer survival International variations in cancer survival Australia, Canada and Sweden better than UK and Denmark Differences greatest for 1- year survival Variations in cancer survival Rural cancer outcomes in Australia worse Approximately 20% worse 5- year survival for common cancers Differences in treatments received (eg radical prostatectomy Baade 2011) Later stage at presentation (eg colorectal cancer Baade 2011) Can some of the variations in cancer survival be improved by earlier diagnosis? Potential approaches Improve uptake of proven screening tests Systematic application of evidence around symptoms as predictors of cancer Community symptom awareness General population Targeted high risk groups General practice level interventions Tumour markers Diagnostic aids Models of ‘diagnostic delay’ Walter, Scott, Webster, Emery. JHSRP 2011 Models of ‘diagnostic delay’ First symptom First contact with the