Campaigns like this don't save lives – they just clog my surgery with people scared witless
10:47 GMT, 5 June 2012
Comedian Ricky Gervais is one of several celebrities fronting a new government campaign to raise awareness about lung cancer. The hope is to save 1,300 lives a year. So why does leading GP DR TONY COPPERFIELD think it’s such a daft idea
Like many of my GP colleagues I think the new campaign to promote public awareness of the symptoms of lung cancer is an incredibly stupid idea.
That might sound illogical, not to say heartless. How can I as a doctor be opposed to a campaign aimed at saving lives Lung cancer is a dreadful disease which is often diagnosed too late to treat successfully and which is the leading cause of cancer deaths in the UK, killing 35,000 every year.
But I can predict what this campaign will lead to. It will unnecessarily freak people out and my surgery will be packed to the rafters with acutely anxious patients, most of whom have little wrong with them.
'Unneccessary': Dr Copperfield claims the high-profile campaign will only encourage basically healthy people who have a bog standard minor illness to rush off to their GP, suspecting they have something far worse
The campaign urges anyone with a cough which lasts three weeks or more to visit their GP. But as any doctor will tell you, three weeks is on average the time that a cough lasts when it’s caused by a straightforward viral infection.
So this is going to encourage loads of basically healthy people who have a bog standard minor illness to rush off to their GP, suspecting they have something far worse.
I’ve already seen this happen during the ‘awareness campaign’ for bowel cancer symptoms which ran earlier this year. At first I was puzzled why so many of my patients were coming to see me complaining only of diarrhoea.
I couldn’t work out why my usually sensible patients were all so obsessed with their bowel movements. Then, after seeing the fourth such patient in a week, the penny dropped after he explained. ‘Haven’t you seen’ he said. ‘It’s been in all the papers and on the telly — bowel cancer awareness.’
The campaign had passed me by, but apparently the Department of Health had been telling people that one of the main symptoms of bowel cancer is loose stools for three weeks or more. (They seem to be obsessed by the magic three weeks, even though guidance from the National Institute for Health and Clinical Excellence — NICE — on bowel cancer states patients should be referred for tests after a more realistic six weeks).
Now, persistent diarrhoea might be a symptom of bowel cancer, but it depends on the context. Loose motions are more worrying if there is also blood in the stool, if you’re over 60 (85 per cent of those with bowel cancer are in this age group) and if there’s a family history of the disease.
GPs are trained to put symptoms in context – for example, the likelihood your cough is lung cancer depends on whether theres an obvious alternative explanation like a virus infection, whether you smoke and how old you are
But the campaign message was such a blunt instrument that many people became needlessly worried they had cancer. Buoyed by the ‘success’ of the bowel cancer campaign, the Department of Health is at it again — with the lung cancer campaign.
But won’t it be worth it if the campaign saves only one life
My answer to this is that this won’t happen if the surgery is so packed with the worried-well that people who are really at risk of cancer find it difficult to get an appointment.
And even if a cancer awareness campaign uncovers one cancer, even if one person is saved, you have to look at the negative side — the terrified patients, the unnecessary work for already overloaded GPs, and even, in some cases, the needless tests and investigations which some people will get referred for, potentially causing delays for those who really need testing.
I don’t know why the government is getting it so wrong. My guess is it’s a case of ‘You can’t be too careful’ — they don’t want to come under fire for any cases of lung cancer being missed.
Also, I suspect it is specialists who advise on these campaigns and the patients they see are the serious cases, so they get a distorted view and are unaware there are masses of people with the same symptom who have nothing seriously wrong and never get as far as a specialist. There isn’t enough input from GPs who can give more of a perspective on minor symptoms like a cough.
Negative impact: Doctors are concerned that many health campaigns encourage people with minor illnesses to rush off to their GPs, driving up waiting times and clinic workloads (file picture)
It may also be true that specialists — and cancer charities — have drums to bang and might decide it’s worthwhile needlessly frightening people if it generates publicity for their particular field.
The lung cancer awareness campaign only went national after a pilot campaign in the Midlands was judged by the Department of Health to have ‘positive results.’
So what were these ‘positive results’ In areas where the pilot ran, more patients went to see their doctors and more were referred to hospital for chest X-rays and CT scans, compared with the same period the previous year.
In other words, the success of the pilot was judged not on whether more cases of lung cancer were detected or whether lives were saved, but on the fact that more people made appointments with their doctors and went to hospital for tests.
It’s not just me who thinks the government has got it wrong.
When I wrote about this recently in a doctors’ magazine, one anonymous NHS worker involved in the pilot said the Department of Health had been told by the pilot sites that three weeks was far too short a period for encouraging patients to go to the doctor with cough symptoms and that six weeks would be more appropriate, but the Department of Health didn’t listen.
GPs are trained to put symptoms in context. The likelihood that you have lung cancer, for example, doesn’t just depend on whether you have a cough but on whether there’s an obvious alternative explanation like a virus infection, as well as your age (lung cancer is most common in people between 75 and 79), and — very important — whether you smoke or have ever smoked.
But this type of campaign ignores the context. The result is a simplistic message which might make a snappy headline — but which will worry a lot of people.
The government needs to look at the negative impact of these campaigns, including the false alarms and the fact that overall, waiting times may be driven up because of the increase in people with minor symptoms being referred to hospital. It needs to take account of these unintended consequences before deciding if a campaign is needed at all.
And if it is needed, the government should be braver and more realistic in its advice to the public.
It needs to forget the easy message which makes for snappy headlines and try to convey the complexities — for example, that an unexplained cough for three weeks in a smoker aged 60 coughing up blood is clearly a different thing from a cough of the same duration in a 20-year-old non-smoker who’s just had a cold.
Obviously, no one wants to see any delays in the diagnosis of a deadly disease like lung cancer.
Being aware of potential symptoms is a good thing — but there’s a difference between improving awareness and generating needless anxiety.
Dr Tony Copperfield is a GP in Basildon, Essex, who writes for Pulse magazine and is the author of Sick Notes: True Stories From The GP’s Surgery, published by Monday Books. He was speaking to CAROLINE LAVENDER.