Several studies have examined delayed and missed diagnosis of cancer.  Here are some of these causes. 

A. Delayed Diagnosis of Cancer Study, General Practitioner

An English study examined diagnostic delay:
• breast (22%)
• bowel (14%)
• cervix (13%)
• skin (8%)
• brain (7%)
• lymphoma (5%)

The study identified the reasons for delay as:

• failure to examine the patient properly;
• inadequate follow-up arrangements;
• lack of appropriate investigations;
• reports misfiled in notes (usually kept in paper files);
• dysfunctional communication between healthcare staff and between healthcare staff
and patients;
• incomplete or inadequate record keeping, and failure to refer or ambiguous prioritisation
of referral.

Published data from the MPS regarding general practice negligence claims also highlights the problems of delayed or misdiagnosis, with cancer forming the largest category in this 1,000 case analysis.  The three main cancers sites were gynecological, digestive organs and breast.

What are the key issues in cancer diagnosis in primary care?
The Scottish Primary Care Cancer Group reports on cancer diagnosis give significant insight into the primary care component in the cancer pathway.61,62 These reports involved analysis of 4,181 cases of cancer diagnosed between 2006 and 2007, and 7,430 between 2007 and 2008. This project offers the most detailed analyses available to date in the UK. It is important to note that fast track electronic referral was not introduced in Scotland until 2006.
The findings of the reports are summarized as:

• Patients with head and neck cancer took the longest time to present (median 30 days). Patients with melanoma and colorectal cancer also presented comparatively late (median 26 days and 21 days).

Primary care perspective
National Patient Safety Agency, March 2010

Delayed diagnosis of cancer: Thematic review
• Patients with bladder cancer, leukaemia, cervical cancer and breast cancer took the shortest time to present from first noticing a sign or symptom.
• There was wide variation between practices in the time taken for patients to be referred to hospital. Patients with breast cancer and melanoma were referred quickly whereas, for other tumor groups (notably lung and prostate), patients spent longer in the primary care part of the journey.
• Even when cancer was suspected patients were not always fast tracked. The report emphasised the importance of implementing referral guidelines and enforcing fast track schemes. It would appear that practices interpreted the guidelines differently.
• Patients with non-specific symptoms and/or co-morbidity caused particular difficulty.
• Level of GP engagement with the national audit was high with GPs showing evidence of reflection and being open about the issue.
• There were differences between practices even in the same health board and between tumour types.
• A significant number of cancers were diagnosed outside of the fast track system. The report called for improvements in routine care and referrals.
• The report highlights the importance of prompt access to investigations in primary care.
• The report’s success suggested that a national process of data collation and synthesis across a region/district is worth considering.

Excerpted from Delayed Diagnosis of Cancer, National Patient Safety Agency.

B. Testing and diagnostic Inaccuracy

Another chief cause if test inaccuracy.  For example, the chest x-ray misses many smaller, treatable  tumors. 



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Howard Gutman has been involved with cancer diagnosis in a personal and professional sense.  He is an attorney who has handled legal claims involving pulmonary and other tumors, and also served as a caregiver for a family member with the disease.    He is the author of the book Lung Cancer and Mesothelioma now entering its second edition. He was a member of the board of directors of a cancer support group matching patients with support people by disease characteristics.   In his legal capacity, he has appeared on Good Day New York, spoken at the National Press Club  and been interviewed by NBC Nightly News.  He has published articles in the New Jersey Lawyer and New Jersey Law Journal for other attorneys. 

Contact Information

Howard A. Gutman, Esq.
230 Route 206, Suite 307
Flanders, New Jersey 07836, 
(973) 598-1980
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315 Madison Avenue, Suite 901

New York, New York 10165


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