Opinion
Reliance on primary care may explain early cancer diagnosis in rural areas
LETTER — Posted Jan. 21, 2008
Regarding "City vs. country: Cancer found at earlier stages in rural patients" (Article, Dec. 3, 2007): I would like to suggest one other theory for researchers to investigate when they consider why some people present with metastatic cancer.
Perhaps the rural residents were more likely to be taken care of by generalists, since specialists are found in cities. Generalists may have put more effort into pushing screening measures such as hemoccults and colonoscopies, being more likely to perceive this as part of their responsibilities.
Beyond that, the patients may have been more likely to bring up symptoms that are unrelated to their chief complaints with a generalist. My patients often ask me about their hemorrhoids or their chronic cough at their visits for their sore elbow or Pap smear or skin rash; would they be as likely to bring up these symptoms with their orthopedist or gynecologist or dermatologist?
They even bring up these low-acuity items at their kids' visits, which probably doesn't happen as often with the urban pediatrician.
Having a medical home that is receptive to all sorts of complaints may be even more important to picking up early cancer than getting all your screening tests, as shown by the difference in both lung cancer and colon cancer grades. It's a theory to consider.
Kathleen G. Todd, MD, Valdez, Alaska
Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/01/21/edlt0121.htm.
