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GPs and Patients Can Help Reduce Misdiagnosis

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GPs and Patients Have A Crucial Role To Play In Early Diagnosis of Pancreatic Cancer

Written By Carlin Kuhlmann
October 22, 2018

Of the estimated 55,440 individuals who will be diagnosed with pancreatic cancer in the U.S. in 2018, fewer than 4,800 will live longer than five years. 74% of patients will die within one year. The average 5-year survival rate is only about 8.5%, the worst of all tumor-type cancers.

These dismal statistics are in large part explained by late diagnoses when the disease has advanced beyond the pancreas and is very difficult to treat. In its early stages, pancreatic cancer often occurs with no signs or symptoms, making it difficult to diagnose, but in some cases, symptoms do appear in the earlier stages. Jaundice, dark urine, light-colored or greasy stools, itchy skin, pain in the belly or back, unexplained weight loss, poor appetite, nausea, fatigue, new onset or recent worsening of diabetes and general feelings of malaise can all be indicators of pancreatic cancer.

Because these symptoms can be rather non-specific and are also indicative of other common illnesses, physicians may not consider the possibility of pancreatic cancer until the disease has progressed. In a study of 313 patients with pancreatic cancer, 31% were initially misdiagnosed. Gallbladder disease and gastroesophageal reflux disease (GERD), whose symptoms closely mirror those of pancreatic cancer, were the two most common misdiagnoses.[1]

When unexplained physical symptoms or changes in our health appear, general practitioners are typically the first line of defense. But GPs by their very nature are not specialists and may not be apt to consider pancreatic cancer if they don’t know the subtleties of the disease. The need for GPs to be more educated and aware on the identification of pancreatic cancer is great. What’s more, poor communication between a doctor and his or her patient can mean important signs or risk factors that could lead to the right diagnosis get missed.

A study performed in the UK demonstrated that for one in three patients who were later diagnosed with pancreatic cancer, it took at least three visits with their general practitioner before they were referred to a specialist, delaying diagnosis and losing valuable time.[2]

Early and accurate diagnosis of pancreatic cancer is key to survival and as patients, we have an important role to play. Along with our doctors, we are key members of our health care team; we must become active participants. This means being aware of the risk factors, knowing our personal and family medical history, and listening to our bodies when unexplained symptoms arise. Perhaps most importantly, it means being open and when necessary, assertive in communicating with our doctors.

Know The Risk Factors. Know Your Family History of Cancer.

Risk factors for pancreatic cancer include tobacco use, obesity or being overweight, diabetes, chronic pancreatitis, cirrhosis of the liver, and infection of the stomach with H. pylori.[3]

Family history of cancer can also be a risk factor. 10-15% of pancreatic cancers are hereditary, meaning they are caused by an inherited genetic mutation. These Genetic Mutations can be associated with multiple different types of cancer including pancreatic, so knowing your family’s cancer history is critical.

If you are currently experiencing or have a genetic family history of these risk factors, it is important that your doctor is aware (especially if you have experienced any pancreatic cancer symptoms). Certain risk factors may indicate a patient has a higher likelihood for developing the disease. Patients deemed high-risk can be followed by a specialist or through specialized screening programs with the intent of detecting pancreatic cancer at the earliest stage possible should it arise. If you have a family history of any cancer, consider Genetic Counseling and Genetic Testing.

Know When To Seek A Second Opinion

Two-way communication is fundamental to an effective physician-patient relationship and is a key factor in accurate and timely disease diagnosis. In fact, “communication breakdowns are emerging as a leading preventable cause of diagnostic errors,” according to Hardeep Singh, M.D., M.P.H., Chief of the Health Policy, Quality & Informatics Program of the U.S. Department of Veterans Affairs.[4]

We must be willing to be forthcoming with our doctors about our symptoms and medical history. And we must insist that they hear us.

The combination of new unexplained symptoms and one or more risk factors linked to pancreatic cancer likely warrants further examination, and the possibility of pancreatic cancer should not be easily dismissed. If another diagnosis is made or if no diagnosis is made, a second opinion may be the right next step. In fact, a good doctor will encourage this.

Pancreatic cancer is treatable when caught early, and we must do our part to ensure the earliest diagnosis possible. Ultimately, no one knows your body like you do. Listen to it, know its history, and clearly communicate that information to your doctors. It could save your life.

Related Information

How Crucial is Early Detection of Pancreas Cancer?

Assessing Your Genetic Risk of Pancreatic Cancer

Diagnostic Images Are Appropriate To Look For Evidence of Pancreatic Cancer

Sources

[1] Mechcatie, E. (2015, July 6). DDW: Study Finds Pancreatic Cancer Misdiagnosis Rate at 31%. https://www.mdedge.com/familypracticenews/article/101026/gastroenterology/ddw-study-finds-pancreatic-cancer-misdiagnosis#

[2] Lyratzopoulos et al., (2013) Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers. BJC 1-5 doi: 10.1038/bjc.2013.1

[3] Pancreatic Cancer Risk Factors. The American Cancer Society. https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html

[4] Singh, H. (2013 June, 3). Diagnostic Error: Safe and Effective Communication to Prevent Diagnostic Errors. https://www.psqh.com/analysis/safe-and-effective-communication-to-prevent-diagnostic-errors/#