The hidden culprits: Understanding delayed cancer diagnosis

By Jules Murtha | Medically reviewed by Nitin Chandramouli, MD FACP
Published March 17, 2023

Key Takeaways

  • Research shows that patients with cancer who get diagnosed early have a better chance of survival, as well as better experiences with treatment and higher quality of life than those whose diagnosis is delayed.

  • A late cancer diagnosis can occur because the patient fails to catch the early warning signs, or because the primary care physician overlooks symptoms or fails to test on time.

  • Physicians can strive to achieve early cancer detection through regular screening tests such as mammograms, Pap tests, and low-dose computed tomography (LDCT).

“Timing is everything.”

This quote is particularly relevant to cancer diagnosis, the timing of which can determine the efficacy of treatment, the patient’s quality of life, and whether or not they’ll survive, according to The Lancet Oncology.[]

Too many patients miss out on the opportunity to heal their cancer due to delayed diagnosis. In order to give patients with cancer a greater chance at surviving and enjoying their lives, doctors can work to better identify the early warning signs and implement regular screening tests.

Why the delay in diagnosis?

When it comes to the timing of a cancer diagnosis, there are a few reasons why the diagnosis can be delayed.

According to a study published by the South Asian Journal of Cancer, delays in cancer diagnosis can occur at several different points in the process.[]

On the other hand, primary care physicians can also overlook symptoms that may be indicative of cancer, and not refer them on time. Patients in secondary care also may not be seen on time or may be referred to the wrong specialist.

The authors of the South Asian Journal of Cancer article also note that delays can be a function of the type of tumor presentation or where the cancer is located.

The researchers studied 158 patients with head and neck cancers, the most common being oral cavity (43.7%) and pharynx (29.1%). These cancers were predominantly identified in Stage II (median).

In the analysis of 252 women with breast cancer, the most common stage observed was Stage III.

On top of misidentification of symptoms, delays in cancer diagnoses may be linked to patients’ socioeconomic status.

One systematic review published by The Oncologist takes a comprehensive look at delays and barriers associated with advanced stage presentation of cancer in low- and middle-income countries (LMICs).[]

The review found that when compared with patients from other income groups, patients from low income countries experience remarkably longer access intervals, or time between the onset of symptoms and addressing them with a health professional.

"Studies from low‐income countries had significantly longer access intervals (median, 6.5 months) compared with other country income groups," the authors wrote.

"Patients with breast cancer had longer delay intervals than patients with childhood cancer. No significant variation existed between geographic regions," they added. "Low health literacy was reported most frequently in studies describing barriers to cancer diagnosis and was associated with lower education level, no formal employment, lower income, and rural residence."

This data highlights the need for early diagnosis strategies to address barriers associated with later stage presentation of cancer in patients from LMICs.

Early screening tests

Knowing that patients who get an early diagnosis have a better overall chance of survival, what can doctors do to offer as timely a diagnosis as possible?

Early diagnosis relies on early detection, which is commonly achieved through screening tests.

According to the CDC, regular screening tests for breast, cervical, and colorectal cancers can help physicians detect them early on.[] 

For breast, cervical, and colorectal cancers, treatment works best when they are caught early.

For example, mammograms, Pap tests, and colorectal screening tests can all aid in early detection of corresponding cancers (sometimes before patients even experience symptoms).

Experts also encourage patients who are at high risk of lung cancer to undergo screening, which can be done with low-dose computed tomography (LDCT). This form of screening may be crucial for those who are 50 to 80 years of age and have a history of heavy smoking, actively smoke now, or quit within the past 15 years.

Outside of screening tests, the authors of the South Asian Journal of Cancer article note that it’s important for all stakeholders involved to do their best to lower the barriers to timely cancer diagnosis. You can do so by:

  • Promoting social awareness of cancer signs and screening tests

  • Regularly updating primary care physicians about alarming symptoms of cancer

  • Developing guidelines to identify these symptoms

  • Promoting continuity of care

  • Enabling patients’ access to specialist expertise through prompt referral

Overall, physician awareness of a patient’s socioeconomic status may help you to understand how financial barriers—both direct and indirect—may affect the timing of a cancer diagnosis.

Being sure that your patients avail themselves of early detection methods can help you address the issue of delayed diagnosis and help patients experience a healthy life for as long as possible.

What this means for you

Early cancer detection and diagnosis is often the key to an effective course of treatment and higher quality of life for the patient. Patients and physicians alike often miss some of the early warning signs, which hurt the patient’s chance of survival. In order to detect cancer as early as possible, physicians can familiarize themselves with often-overlooked warning signs, and implement regular screening tests as necessary.

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