Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus.
Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University; the Danish Clinical Registries (RKKP), Aarhus.
Br J Gen Pract. 2019 Feb;69(679):e80-e87. doi: 10.3399/bjgp19X700769. Epub 2019 Jan 14.
Patients who rarely consult a GP in the 19-36 months before a cancer diagnosis have more advanced cancer at diagnosis and a worse prognosis. To ensure more timely diagnosis of cancer, the GP should suspect cancer as early as possible.
To investigate the GP's suspicion of cancer according to the patient with cancer's usual consultation pattern in general practice.
A cross-sectional study based on survey data from general practice of 3985 Danish patients diagnosed with cancer from May 2010 to August 2010, and linked to national register data.
Using logistic regression analysis with restricted cubic splines, the odds ratio (OR) of the GP to suspect cancer as a function of the patient's number of face-to-face consultations with the GP in the 19-36 months before a cancer diagnosis was estimated.
GPs' cancer suspicion decreased with higher usual consultation frequency in general practice. A significant decreasing trend in ORs for cancer suspicion was seen across usual consultation categories overall (<0.001) and for each sex (males: <0.05; females: <0.05). GPs' cancer suspicion was lower in patients aged <55 years in both rare and frequent attenders compared with average attenders.
GPs suspect cancer more often in rare attenders ≥55 years. GPs' cancer suspicion was lower in younger patients (<55 years), in both rare and frequent attenders. GPs should be aware of possible missed opportunities for cancer diagnosis in young attenders and use safety netting to reduce the risk of missing a cancer diagnosis.
在癌症诊断前的 19-36 个月内很少看全科医生的患者，在诊断时癌症已更晚期，预后更差。为确保癌症能得到更及时的诊断，全科医生应尽早怀疑癌症。
根据癌症患者在普通科就诊的常见就诊模式，调查全科医生对癌症的怀疑。
一项基于 2010 年 5 月至 8 月丹麦 3985 名癌症诊断患者的普通科调查数据的横断面研究，这些数据与国家登记数据相关联。
使用逻辑回归分析受限立方样条，根据患者在癌症诊断前 19-36 个月内与全科医生面对面就诊的次数，估计全科医生怀疑癌症的几率比（OR）。
全科医生对癌症的怀疑程度随着普通科就诊频率的增加而降低。全科医生对癌症的怀疑呈显著下降趋势，整体上（<0.001）和各性别（男性：<0.05；女性：<0.05）的常见就诊类别中均如此。与普通就诊者相比，<55 岁的罕见就诊者和频繁就诊者的癌症怀疑率较低。
在≥55 岁的罕见就诊者中，全科医生更常怀疑癌症。在年轻患者（<55 岁）中，无论是罕见就诊者还是频繁就诊者，全科医生对癌症的怀疑率都较低。全科医生应注意年轻就诊者可能错失癌症诊断的机会，并使用安全网降低漏诊癌症的风险。
