GPs are to refer suspected cancer patients for tests in a week under new schemeBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3994 (Published 29 September 2009) Cite this as: BMJ 2009;339:b3994
All rapid responses
It has long been recognised that UK patients with cancer tend to
present to specialist services at later stages than those in economically
similar countries; the accessibility of tests in primary care is a likely
reason. General practitioners may perform their gatekeeping function by
requesting tests when vague symptoms such as those encountered in ovarian
cancer have persisted or worsened during a period of reassurance rather
than a test, such as pelvic ultrasound, being done early to seek either a
diagnosis or a basis for reassurance.
In this respect the response to Professors Mourits and de Bock’s
letter in the same issue  is that whilst early diagnosis of
asymptomatic disease may bring enhanced cure rates, the immediate problem
in the UK is that outcomes of treatment are compromised by late diagnosis
of symptomatic disease.
If the strategy of enhanced access to tests works, we will see more
demand for curative interventions which will require increased capacity;
thoracic surgery is a prime example of a specialty that is under pressure.
The results of the tests will not always be unambiguous which means that
there will be increased workload for the multidisciplinary teams that
However this and the acute oncology concept recently introduced 
provide opportunities for cancer management in the UK to come of age by
acquiring the necessary capacity through high quality multidisciplinary
services in the local acute general hospitals where patients prefer their
care to be.
The economy must not be used as an excuse to deny this to NHS
 Mourits MJ, de Bock GH. Symptoms are not early signs of ovarian
cancer. BMJ 2009; 339: b3955
 NHS National Cancer Action Team. Chemotherapy Services in
England: Ensuring quality and safety - a report from the National
Chemotherapy Advisory Group. London, Department of Health 2009.
Competing interests: No competing interests