Primary prevention, symptomatic diagnosis and screening: roles for general practice and primary care
1University of Edinburgh, Edinburgh, UK
This section of the Lancet Oncology Commission focussed on the role of primary care in prevention, early diagnosis and screening. There is good evidence that interventions based in primary care can lead to reductions associated with alcohol and tobacco consumption. The evidence is more variable when it comes to diet and obesity and in these areas other, complementary approaches are needed. Ideally in all areas of primary prevention primary care should work alongside public health and government initiatives.
Primary care has important roles in awareness raising about cancer symptoms and these can complement other initiatives such as public awareness campaigns. There is a complex process by which patients appraise symptoms and decide whether or not to take action - interactions with primary care have an important influence on this process. It is important for primary care practitioners to understand the psychological processes which govern their patients' help-seeking behaviour in response to cancer-related symptoms.
Primary care also has key roles in cancer screening; in the case of colorectal cancer there is ample evidence that endorsement from primary care leads to higher uptake of screening tests. Primary care practitioners are seen as a credible source of advice about cancer screening decisions and it's vital, even for programmes which are largely co-ordinated outside of primary care, that GPs and other primary care practitioners engage in the screening programme and its various components - particularly recruitment, informed choice and appropriate follow up of positive screening tests.