An international comparative study published in 2013 found that the UK has low awareness of age-related cancer risk and the highest perceived barriers to presenting symptoms the barriers reported as unusually prevalent in the UK included embarrassment and ‘not wanting to bother the doctor’. 21 Tackling the causes of ‘delay’ has become a key part of cancer policy in many countries. Other theories about how people appraise symptoms and make decisions about seeking help include those described by Safer et al, 19 Andersen et al 20 and Scott et al. 15–17 Zola 18, for example, described a set of ‘triggers’ to consultation which include the person's assessments about whether, and how, the problem is interfering with their main roles (work, social, home life, relationships), monitoring how long the symptoms have been present, considering the perceived seriousness of the symptom and expectations about whether there is something that the doctor can do about it, and the responses of family, friends and colleagues who may encourage the person to go to the doctor. A variety of theories and models have been proposed to explain help-seeking behaviour when symptoms are present. How people perceive, evaluate and act on symptoms-known as ‘illness behaviour’ 14-has long been studied by health sociologists. 11 A range of non-specific signs and symptoms have been identified as occurring before a pancreatic cancer diagnosis, sometimes many months ahead of more indicative symptoms, suggesting that acting early on certain symptoms could expedite diagnosis 12, 9 and possibly lengthen survival. There have been a number of studies of prediagnostic symptoms in pancreatic cancer, including a prospective cohort study of a primary care database with a predefined list of symptoms, 4 retrospective analyses of primary care data 5 or hospital records, 6–8 structured interviews using predefined lists of symptoms 9, 10 or a combination of methods.
The 5-year-survival rate is less than 4% in the UK, 3 a statistic that has not changed for 40 years despite improvements in survival of many other cancers. 1 As the ninth most common cancer in the UK with more than 8000 new cases diagnosed each year, 2 a general practitioner (GP) would see one new case approximately every 5 years. Early symptoms of pancreatic cancer are vague and non-specific more indicative signs such as jaundice occur late in the disease, hence most cases are diagnosed at an advanced stage.
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