Delay in diagnosis of gastric cancer: a prospective study evaluating doctors'- and patients' delay and its influence on five year survival.

Despite new diagnostic techniques, gastric cancer in its less aggressive stages is not diagnosed more frequently and the prognosis still remains poor. Thus, a possibility exists that there is still a delay in diagnosis. This study was therefore designed to investigate whether a delay in diagnosis of gastric cancer exists, to identify factors leading to diagnostic delay, and to settle whether the prognosis is dependent on a delay. Fifty consecutive patients with gastric carcinoma were interviewed and the diagnostic attempts prior to diagnosis were checked. It was found that thirteen patients (26%) had patients' delay (more than three months of symptoms before consulting a doctor) whereas twelve (24%) had doctors' delay (more than three months of investigations before correct diagnosis was made). Doctors' delay was more common in female (7/13) than in male patients (5/37) (p less than 0.05) and in linitis plastica (5/8) than in other types of gastric cancers (7/42), (p less than 0.05). Seven of the twelve patients with doctors' delay had been on regular check ups before diagnosis. A negative barium meal was the most common reason for doctors' delay. Survival was influenced only by tumour stage (r = -0.71, p less than 0.05). Our conclusion is that both patients' and doctors' delay are considerable in the diagnosis of gastric cancer; it is therefore suggested that improvement in five-year survival requires improved presymptomatic diagnostic methods and screening programmes.