by Dr. Iain Corness
A Timely Killer
It really is a no-brainer. Early
diagnosis improves the prognosis. A news item a couple of years ago claimed
that if you lived in Taiwan you had a better chance of cancer survival, than
if you lived in the UK. This was put down to the fact that your cancer
diagnosis was done more quickly in Taiwan than it was in the UK.
If my mother’s experience of the UK National Health System was anything to
go by, you will be lucky to live long enough for the diagnosis to be made,
by the time you get given a specialist’s appointment and then wait for the
test results and then see the specialist again. But, I suppose, if nothing
else, it does help cut down the waiting lists!
However, there is a message for us all in this. Timely cancer diagnosis does
improve your chances of survival. This is not really rocket science or some
new breakthrough. If you leave battery acid on your shirt long enough, it
will eat a hole in the fabric. If you leave cancer cells in your body long
enough, they can eat so many good cells your life and living is compromised.
Unfortunately, the diagnosis of cancer is generally not made (or the
diagnostic procedure even started) until the cancer produces some abnormal
symptoms. Those abnormal symptoms are also not made by the cancer itself,
but by the organs that have been attacked, or by the sheer physical size of
the cancer causing physical problems. The cough from cancer of the lung is a
good example of the first case, and constipation from cancer of the bowel is
an example of the second type.
We are actually very lucky in Thailand, as there are several centers of
excellence in the capital and in the provinces, and I include my own
hospital, the Bangkok Hospital Pattaya.
Now when I say “centers of excellence” I am referring to the speed of
diagnosis that is possible, not the treatments that are available. There are
many factors that can influence that speed (the following table has been
extracted from Jiwa et al, BMC Family Practice 2007 8:27)
1. Need to travel to clinics in the capital may have financial and
logistical implications for the patient and therefore lead to
2. Health professional, different gender of GP may deter some patients from
presenting with embarrassing symptoms that require intimate examination for
3. Equivocal tests necessitate repeat visits to clinic.
4. Lack of coordination for individual patients’ needs may result in
inconvenient scheduling of appointments.
5. Limited scope to obtain second opinions.
6. Access to specialists limited by distance from capital.
As you can see from the table, we are very lucky in Thailand, as the centers
of excellence can easily cover the six factors. What is also not expressed
in the six point table, is the speed of test result returns. Where we enjoy
a one hour turnaround for blood tests, patients in the UK receive their
results in days, not minutes. Similarly, appointments for CT scans and MRI’s
are usually ‘same day’ with results usually the same.
So, timely diagnosis is very possible in this country, but unfortunately
there are still instances of late diagnosis, but in the majority of cases
this has occurred through ignoring the symptoms or ignorance of the
importance of the symptoms. The simple advice is to never ignore any
deviation from ‘normal’ in your body - after all, you know your body better
than anyone else.
There is also a somewhat mistaken idea that your annual check-up will
uncover hidden or early cancers, so you don’t have to do anything until next
year. Certainly there are some cancers that are detected in this way, but
whilst the annual check-up can discover many endocrine problems, blood
problems and cardiac abnormalities, it is not going to uncover cancer in the
brain, bones or skin, unless they are very advanced and causing symptoms.
Timely diagnosis does come back to your ability to inform your doctor of
changes. Do not feel embarrassed that it “might be nothing”. Let me assure
you that all doctors prefer telling people that they do not have a problem
after diagnostic testing, than the other way round!