Cancer risk tool sin General Practice

Question 1

What is the epidemiology of cancer presentation to GP in Australia?

Answer 1

• Lung, pancreas, ovarian and myeloma cancers are challenging to diagnose early
• Cancer is the leading cause of disease burden in Australia
• Perceptions of delayy in cancer diagnosis are a leading cause of medico-legal claims in Australia
• GPs diagnose cancer on an average of 7-8 times/year

Question 2

What are the general symptoms of cancer in GP?

Answer 2

• Lung, pancreatic, stomach and myeloma usually have multiple visits before diagnosis compared to breast and endometrial cancer
• Repeat visits with the same symptoms are potential red flags in themselves
• Only about 50% of patients with cancer present with classical alarm symptoms in GP
• Common symptoms of lung cancer include unexplained or persistent haemoptysis, cough, chest or shoulder pain, SOB, hoarseness, unresolved chest infection, clubbing, lymph node enlargement and weight loss
• Common symptoms of ovarian cancer include abdominal bloating, loss of appetite, unexplained weight loss, contipation, heart burn, back pain, fatigue, abdominal/pelvic pain

Question 3

What are the limitations of risk charts such as CAPER?

Answer 3

• Individual baseline risk factors such as age, family history, smoking are not accounted for
• A positive predictive value of >5% on a Caper chart needs urgent specialist review and repeat symptom increases the PPV
• Hippisley Cox Q Cancer model address these issues to a limited extent and account for more than one type of cancer as common symptoms are addressed