Can safety-netting improve cancer detection in patients with vague symptoms?

Abstract

Patients present daily about symptoms that could represent a new diagnosis of cancer (1). Some will present with easily recognised high-risk symptoms such as dysphagia (5% likelihood of cancer if age >55 years), post-menopausal bleeding (4% likelihood if age >55 years), or haemoptysis (2% likelihood if age >40 years). But most will have vague or non-specific symptoms such as cough, fatigue, or abdominal pain (2-4). As these symptoms are shared with benign, chronic, or self-limiting conditions, the likelihood of cancer is low (mostly under 0.5%) (1). The clinical consequence is that diagnosis of cancers with vague symptoms tend to be delayed – for example, 51% of patients with multiple myeloma have to consult 3 or more times before referral (5) and 37% present to hospital as emergencies (6). Depending on the cancer site, reducing diagnostic delay can lead to improved survival, earlier-stage at diagnosis, and improved quality of life