title: The role of general practice in routes to diagnosis of lung cancer in Denmark: a population-based study of general practice involvement, diagnostic activity and diagnostic intervals.
abstract: BACKGROUND
  Lung cancer stage at diagnosis predicts possible curative treatment. In Denmark and the UK, lung cancer patients have lower survival rates than citizens in most other European countries, which may partly be explained by a comparatively longer diagnostic interval in these two countries. In Denmark, a pathway was introduced in 2008 allowing general practitioners (GPs) to refer patients suspected of having lung cancer directly to fast-track diagnostics. However, symptom presentation of lung cancer in general practice is known to be diverse and complex, and systematic knowledge of the routes to diagnosis is needed to enable earlier lung cancer diagnosis in Denmark. This study aims to describe the routes to diagnosis, the diagnostic activity preceding diagnosis and the diagnostic intervals for lung cancer in the Danish setting.
  
  
  METHODS
  We conducted a national registry-based cohort study on 971 consecutive incident lung cancer patients in 2010 using data from national registries and GP questionnaires.
  
  
  RESULTS
  GPs were involved in 68.3% of cancer patients' diagnostic pathways, and 27.4% of lung cancer patients were referred from the GP to fast-track diagnostic work-up. A minimum of one X-ray was performed in 85.6% of all cases before diagnosis. Patients referred through a fast-track route more often had diagnostic X-rays (66.0%) than patients who did not go through fast-track (49.4%). Overall, 33.6% of all patients had two or more X-rays performed during the 90 days before diagnosis. Patients whose symptoms were interpreted as non-alarm symptoms or who were not referred to fast-track were more likely to experience a long diagnostic interval than patients whose symptoms were interpreted as alarm symptoms or who were referred to fast-track.
  
  
  CONCLUSIONS
  Lung cancer patients followed several diagnostic pathways. The existing fast-track pathway must be supplemented to ensure earlier detection of lung cancer. The high incidence of multiple X-rays warrants a continued effort to develop more accurate lung cancer tests for use in primary care.
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. louise.guldbrandt@ph.au.dk.|Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark. louise.guldbrandt@ph.au.dk.
authors.forename: Louise Mahncke
authors.initials: LM
authors.lastname: Guldbrandt
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. mfgr@ph.au.dk.
authors.forename: Morten
authors.initials: M
authors.lastname: Fenger-Grøn
authors.affiliation: Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark. torbrasm@rm.dk.
authors.forename: Torben Riis
authors.initials: TR
authors.lastname: Rasmussen
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. henry.jensen@feap.dk.|Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark. henry.jensen@feap.dk.
authors.forename: Henry
authors.initials: H
authors.lastname: Jensen
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. p.vedsted@feap.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003815:Dentists; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005060:Europe; D005194:Family Practice; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D024382:Professional Role; D012017:Referral and Consultation; D012042:Registries; D012107:Research Design; D011795:Surveys and Questionnaires; D055815:Young Adult