Early detection of cancers
General practitioners and the general practice team play an important role in the prevention and detection of cancers by providing evidence based advice, opportunistic case finding or screening where appropriate, especially in the case of skin, cervical, breast and colorectal cancer (CRC). This process involves encouraging age and risk appropriate patients to participate in population screening programs; as well as risk assessment and screening by the GP or appropriately trained practice staff.
Barriers to screening for cancer include concerns about cost; radiation; embarrassment; poor access, including travel difficulties; anxiety about test results; inconvenience; forgetting or procrastination; and discomfort associated with the screening test.351 Strategies to overcome these are discussed in the ‘green book’. Screening not supported by evidence can lead to harm from anxiety or tests and treatments that would not have happened otherwise.
Health inequality
Some cancers are more common in low SES groups. Aboriginal women, older women and women living in low socioeconomic areas have a higher incidence of cervical cancer.352 Oral cancer is more prevalent among low SES groups.353 Low income and less educated patients are less likely to be screened and more likely to be diagnosed with late stage CRC.354-356
Women of low SES are less likely to have a mammogram357 or to have attended health services for a Pap test.358 This is not corrected by increased access to general practice.357 Aboriginal and Torres Strait Islander women are less likely to take part in both cervical and breast cancer screening and are also less likely to attend for second round screening if they report symptoms. This is also true for women from non-English speaking backgrounds.359
To increase screening in these community groups, strategies must address barriers to preventive care including financial and structural barriers (including transport). Strategies include providing longer consultations to disadvantaged patients with complex needs (see the ‘green book’ for more details).
© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook