title: Delay in diagnosis of lung cancer in general practice.
abstract: BACKGROUND
  Lung cancer is a common cancer disease; nevertheless, in Denmark a GP only sees one new case of lung cancer per year. The core symptoms of lung cancer, cough and dyspnoea, are on the other hand very common in general practice. This represents a challenge to the diagnostic process and increases the risk of diagnostic delay.
  
  
  OBJECTIVE
  To explore diagnostic delay in primary health care among patients with lung cancer.
  
  
  METHODS
  A population based observational case series of 84 lung cancer patients' delay.
  
  
  METHODS
  The County of Aarhus, Denmark.
  
  
  METHODS
  From county-based registers of all histological and cytological tests we identified all patients in the County of Aarhus with lung cancer diagnosed during a 6 month period in 2003. Inclusion was verified by contacting the departments involved in the treatment of lung cancer. Data were based on telephone interviews with patients' GPs. A review of delay was made starting with the first symptom until referral to secondary care.
  
  
  RESULTS
  The overall median delay in primary health care was 32.5 days (interquartile interval (IQI) = 12-68 days). One-third of the patients were referred to the diagnostic investigation after their first consultation. Important reasons for delay in primary care were: symptoms not related to the lungs, chest X-ray without suspicion of cancer, comorbidity, waiting times for investigations and lack of explicit follow-up appointment. Prolonged delay was often due to a combination of these factors.
  
  
  CONCLUSIONS
  When diagnosing lung cancer, it is important that GPs are aware of the low sensitivity of chest X-ray. Shorter waiting times for investigations could reduce delay considerably.
authors.affiliation: Research Unit and Department for General Practice, Aarhus University, Aarhus, Denmark. mb@alm.au.dk
authors.forename: Marianne
authors.initials: M
authors.lastname: Bjerager
authors.forename: Torben
authors.initials: T
authors.lastname: Palshof
authors.forename: Ronald
authors.initials: R
authors.lastname: Dahl
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005194:Family Practice; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D013997:Time Factors