title: Improving early diagnosis of symptomatic cancer.
abstract: Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
authors.affiliation: University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.affiliation: School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
mesh_terms: D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards*; D006291:Health Policy; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D000069342:Medical Overuse; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000401:mortality; D018579:Patient Selection; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors