Rethinking diagnostic delay in cancer: how difficult is the diagnosis?

The timely diagnosis of cancer is a frequent theme in the lay press and an increasingly common topic for quality improvement initiatives. 2 The UK’s health secretary has advocated ranking general practices on the NHS Choices website according to how promptly patients subsequently diagnosed with cancer are referred to specialist services for suspected cancer. But is such a policy based on evidence? Its main assumption is that the multiple visits made by these patients to primary care before referral chiefly reflect poor professional performance rather than factors such as clinical complexity, reasonable watchful waiting, or the need for appropriate investigations in primary care. We review the occurrence of multiple pre-referral consultations and discuss how a better understanding of variation between cancers might improve the timeliness of diagnosis. How common aremultiple consultations?