Kreftdiagnostikk i almenpraksis VI. Innholdet i kreftfaresignalene. Er "varige smerter" aktuelt som faresignal?

Abstract

Antallet og innholdet i kreftfaresignalene er blitt endret flere ganger siden de ble introdusert i USA under første verdenskrig. Faresignalene er forsøkt utformet slik at de hjelper mennesker med kreft til raskest mulig å søke lege, uten å skape unødig angst i befolkningen og øke "trivialitets"-belastningen i helsevesenet. <br> Her diskuteres denne målsetningen, og jeg undersøker nærmere et tidligere forslag (6) om å ta "Smerter som ikke flytter seg eller går over" med som et åttende faresignal. Forslaget frafalles fordi symptomet i enda høyere grad enn de syv faresignalene viser seg å være uspesifikt som kreftsymptom, og fordi sensitiviteten av dette faresignalforslaget hos kreftsyke i tidlig stadium heller ikke er spesielt høyt.

<p>The number as well as the content of “warning signals” of cancer have been changed several times since the signals were introduced in the USA during World War I. Ideally, the signals should be formulated to help as many as possible of the cancer patients to see their doctor as early as possible in the course of disease. At the same time it is important not to increase unnecessary anxiety in the population, and not to increase the “triviality”-burden of to-day’s medical practice. <p>I have earlier suggested (6) including “pain which persists and does not move” in the list of warning signals. The basis for this suggestion is examined in different ways using data from records made by general practitioners as well as interviews in a patient population and in the general population of Tromsø, Norway. The symptom is also considered for a group of cancer patients and for their matched control patients without cancer. <p>The findings do not defend a recommendation to include this symptom in the list of warning signals. As a cancer symptom, enduring pain has too low specificity, and it does not occur particularly often in the early forms of cancer.