Lung cancer is symptomatic in over 90% of patients. However, studies find that delays between reporting of symptoms and diagnosis are universal. In a recent Swedish study, 134 lung cancer patients were investigated prospectively. The median delay for the patients, i.e. from the first symptom(s) until the family doctor was contacted, was 21 days. From the first contact with the doctor until referral to the specialist the median time was 33 days. From the first visit to the specialist to diagnosis the median time was 9 days. The median time from first symptom(s) until treatment or the decision not to treat (the sum of all delays) was 189 days, i.e. 6 months. A large epidemiological survey from Poland in 561 lung cancer patients registered from 1995 to 1998, reported that the median delay caused by patients was 46 days. The median delay caused by doctors (time between first visit to the doctor and the date of diagnosis) was 65 days and the median time between diagnosis and therapy was an additional period of 30 days. Delays were significantly different from region to region. A retrospective audit of the time involved in the management of patients with lung cancer referred for consideration of surgery at the Royal Brompton Hospital in London has been previously carried out on 194 patients. The median interval between the onset of symptoms and their first chest radiograph was 39 days, and between the onset of symptoms and referral to a surgeon by a chest physician was 112 days. In conclusion, the2-month delay between the onset of the first symptom andthe first referral to a lung cancer specialist (a time course that includes both patient and family doctor delay) is somewhat longer than the average national delay (whose figure of 50 days also included the specialist delay) and roughly on line or somewhat better than reported internationally.
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