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Metastatic breast cancer goes undiagnosed for too long

GPs and leading charity call for support for GPs, better diagnostics, longer with patients and greater awareness of secondary breast cancer

Louise Prime

Friday, 11 October 2019

GPs need better access to the right diagnostics and more time with their patients to enable them to diagnose cases of metastatic breast cancer more quickly, the Royal College of GPs (RCGP) insisted this morning. New research* from Breast Cancer Now has revealed that many people with secondary breast cancer had experienced delays in diagnosis, amid continued challenges for healthcare professionals in recognising its signs and symptoms – so it is calling for better support for GPs and for action to raise awareness of what secondary breast cancer is.

A survey for the charity of 2,102 people living with secondary breast cancer in the UK took place from June to August this year. It revealed that:

  • Among women who had previously been treated for primary breast cancer, nearly one in four (24%) had visited their GP three or more times with symptoms before being diagnosed with the return and spread of the disease.
  • Among respondents who had had a prior diagnosis of breast cancer (1,463 of 2,102 women), just 13% said they had been given enough information about the potential signs and symptoms of the return and spread of the disease to look out for after their initial treatment.
  • Among respondents who had visited their GP having previously been treated for breast cancer, 20% were treated for another health condition by their GP before eventually being diagnosed with secondary breast cancer.
  • Just 73% of respondents had been given the name of a clinical nurse specialist (CNS) at their diagnosis, with only 30% seeing a CNS regularly.

Breast Cancer Now is calling for new tools and resources for GPs, and urged that, in people who have previously been treated for primary breast cancer, non-specific but persistent signs and symptoms of metastatic breast cancer must be investigated and taken seriously. These include: unexpected weight loss or loss of appetite; discomfort or swelling under the ribs or across the upper abdomen; severe or ongoing headaches; altered vision or speech; feeling sick most of the time; breathlessness or a dry cough; loss of balance or weakness or numbness of the limbs; any lumps or swellings under the arm, breastbone or collarbone; pain in the bones (e.g. back, hips or ribs) that doesn’t get better with pain relief and might be worse at night. It said that although many of these symptoms can have other causes, patients should be encouraged to report any new and persistent symptoms so they can be assessed appropriately.

The RCGP said that GPs are highly trained to spot cancer, but agreed that they need more diagnostics – and more time with their patients. College chair Professor Helen Stokes-Lampard commented: “GPs… understand the importance of timely cancer diagnosis and are highly-trained to identify possible symptoms of cancer and its recurrence. But some symptoms are very difficult to interpret because they are vague in the initial stages, or indicative of other, more common conditions – in other cases, there may be no symptoms at all.

“We are actually making positive progress on cancer diagnosis in primary care, but GPs must have better access to the right diagnostic tools in the community and the appropriate training to use them.

“Over one million patients will visit their GP surgery today alone, but the number of GPs has not kept pace with patient demand, and the traditional 10-minute consultation is no longer enough for patients with complex needs. We urgently need greater investment in our family doctor service so that we are properly resourced and can give our patients the time they need.

“Cancer is an enduring priority for the RCGP, and we have worked with Cancer Research UK, Macmillan and others to develop excellent resources to support GPs and other healthcare professionals in the timely diagnosis of all cancers.”

Breast Cancer Now is petitioning the secretary of state for health and social care, the cabinet secretary for health and sport, the minister for health and social services and the secretary of state for Northern Ireland to support its recommendations to improve the diagnosis, treatment and support offered to people living with secondary breast cancer.

*Good enough? Breast cancer in the UK. A report prepared by Breast Cancer Now, October 2019.

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