The UK has a poor record on cancer survival: international studies such as Eurocare and the International Cancer Benchmarking Partnership (ICBP) have consistently demonstrated that cancer survival rates in the UK are significantly worse than in other developed countries. For example, in data from 2005–2007, only 8.8% of patients diagnosed with lung cancer in the UK survived for 5 years, compared with 18.4% in Canada.1 These differences are thought to reflect an increased incidence of cancer diagnosed in the UK at a late clinical stage, so-called ‘delayed diagnosis’.

The causes of delayed diagnosis of cancer in general practice (primary care delay) in the UK remain uncertain. It has been consistently suggested that the ‘gatekeeping’ role of GPs in the UK contributes to the problem. When asked to consider (fictitious) cases of possible cancer, UK GPs were less likely to consider immediate investigation or referral than doctors from countries with higher survival rates.2 However, no good correlation was found between gatekeeping and cancer survival in an international comparison of healthcare systems.3 Relatively poor access to CT/MRI and to specialist advice may also contribute to the problem in the UK.

Recent data show that cancer survival rates in the UK are improving. However, this is also true in other countries, such that the gap between the UK and best-performing countries remains, with one or two notable exceptions, such as with breast cancer.

So although research into primary care delay continues, we would like to offer some practical advice on cancer diagnosis for GPs in their everyday practice.