{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:40:00Z","timestamp":1792071600419,"version":"4.4.0"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>General practitioners (GPs) have a key role in the diagnosis of cancer. It is crucial to identify factors influencing the decision to refer for suspected cancer. The aim of this study was to investigate the alignment between the patient\u2019s cancer worry and the GP\u2019s suspicion of cancer in the first clinical encounter and the association with the time interval from the first symptom presentation until the first referral to specialist care, i.e. the primary care interval (PCI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>The study was performed as a cross-sectional study using survey data on patients diagnosed with incident cancer in 2010 or 2016 and their GPs in Denmark. We defined four alignment groups: 1)\u00a0patient worry and GP suspicion, 2)\u00a0\u00a0GP suspicion only, 3)\u00a0patient worry only, and 4)\u00a0none of the two. A long PCI was defined as an interval longer than the 75th percentile.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among the 3333 included patients, both patient worry and GP suspicion was seen in 39.5%, only GP suspicion was seen in 28.2%, only patient worry was seen in 13.6%, and neither patient worry nor GP suspicion was seen in 18.2%. The highest likelihood of long PCI was observed in group 4 (group 4 vs. group 1: PPR 3.99 (95% CI 3.34\u20134.75)), mostly pronounced for easy-to-diagnose cancer types.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Misalignment between the patient\u2019s worry and the GP\u2019s suspicion was common at the first cancer-related encounter. Importance should be given to the patient interview, due to a potential delayed GP referral among patients diagnosed with \u201ceasy-to-diagnose\u201d cancer types presenting with unspecific symptoms.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-021-01480-2","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T17:02:57Z","timestamp":1624554177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Alignment between the patient\u2019s cancer worry and the GP\u2019s cancer suspicion and the association with the interval between first symptom presentation and referral: a cross-sectional study in Denmark"],"prefix":"10.1186","volume":"22","author":[{"given":"Line Flytkj\u00e6r","family":"Virgilsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anette Fischer","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vedsted","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitte Stentebjerg","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"issue":"1","key":"1480_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1158\/1055-9965.EPI-15-0578","volume":"25","author":"LA Torre","year":"2016","unstructured":"Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer incidence and mortality rates and trends--an update. Cancer Epidemiol Biomark Prev. 2016;25(1):16\u201327. https:\/\/doi.org\/10.1158\/1055-9965.EPI-15-0578.","journal-title":"Cancer Epidemiol Biomark Prev"},{"issue":"9972","key":"1480_CR2","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/S0140-6736(14)62038-9","volume":"385","author":"C Allemani","year":"2015","unstructured":"Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977\u20131010. https:\/\/doi.org\/10.1016\/S0140-6736(14)62038-9.","journal-title":"Lancet"},{"issue":"11","key":"1480_CR3","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1016\/S1470-2045(19)30456-5","volume":"20","author":"M Arnold","year":"2019","unstructured":"Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TM, Myklebust TA, et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol. 2019;20(11):1493\u2013505. https:\/\/doi.org\/10.1016\/S1470-2045(19)30456-5.","journal-title":"Lancet Oncol"},{"issue":"1","key":"1480_CR4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1038\/nrclinonc.2013.212","volume":"11","author":"JD Emery","year":"2014","unstructured":"Emery JD, Shaw K, Williams B, Mazza D, Fallon-Ferguson J, Varlow M, et al. The role of primary care in early detection and follow-up of cancer. Nat Rev Clin Oncol. 2014;11(1):38\u201348. https:\/\/doi.org\/10.1038\/nrclinonc.2013.212.","journal-title":"Nat Rev Clin Oncol"},{"issue":"Suppl 2","key":"1480_CR5","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1038\/sj.bjc.6605383","volume":"101","author":"F Olesen","year":"2009","unstructured":"Olesen F, Hansen RP, Vedsted P. Delay in diagnosis: the experience in Denmark. Br J Cancer. 2009;101(Suppl 2):S5\u20138. https:\/\/doi.org\/10.1038\/sj.bjc.6605383.","journal-title":"Br J Cancer"},{"issue":"1","key":"1480_CR6","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.healthpol.2011.11.001","volume":"105","author":"HB Probst","year":"2012","unstructured":"Probst HB, Hussain ZB, Andersen O. Cancer patient pathways in Denmark as a joint effort between bureaucrats, health professionals and politicians--a national Danish project. Health Policy. 2012;105(1):65\u201370. https:\/\/doi.org\/10.1016\/j.healthpol.2011.11.001.","journal-title":"Health Policy"},{"issue":"12","key":"1480_CR7","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/S1470-2045(15)00205-3","volume":"16","author":"G Rubin","year":"2015","unstructured":"Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, et al. The expanding role of primary care in cancer control. Lancet Oncol. 2015;16(12):1231\u201372. https:\/\/doi.org\/10.1016\/S1470-2045(15)00205-3.","journal-title":"Lancet Oncol"},{"issue":"1","key":"1480_CR8","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1186\/1471-2407-14-636","volume":"14","author":"H Jensen","year":"2014","unstructured":"Jensen H, Torring ML, Olesen F, Overgaard J, Vedsted P. Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study. BMC Cancer. 2014;14(1):636. https:\/\/doi.org\/10.1186\/1471-2407-14-636.","journal-title":"BMC Cancer"},{"issue":"11","key":"1480_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023870","volume":"8","author":"D Weller","year":"2018","unstructured":"Weller D, Menon U, Zalounina Falborg A, Jensen H, Barisic A, Knudsen AK, et al. Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the international Cancer benchmarking partnership (ICBP). BMJ Open. 2018;8(11):e023870. https:\/\/doi.org\/10.1136\/bmjopen-2018-023870.","journal-title":"BMJ Open"},{"issue":"8","key":"1480_CR10","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1038\/bjc.2012.408","volume":"107","author":"L Elliss-Brookes","year":"2012","unstructured":"Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, et al. Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. Br J Cancer. 2012;107(8):1220\u20136. https:\/\/doi.org\/10.1038\/bjc.2012.408.","journal-title":"Br J Cancer"},{"issue":"5","key":"1480_CR11","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1111\/j.1365-2354.2005.00600.x","volume":"14","author":"VL Allgar","year":"2005","unstructured":"Allgar VL, Neal RD. General practictioners\u2019 management of cancer in England: secondary analysis of data from the National Survey of NHS patients-Cancer. Eur J Cancer Care. 2005;14(5):409\u201316. https:\/\/doi.org\/10.1111\/j.1365-2354.2005.00600.x.","journal-title":"Eur J Cancer Care"},{"issue":"Suppl 1","key":"1480_CR12","doi-asserted-by":"publisher","first-page":"S35","DOI":"10.1038\/bjc.2015.40","volume":"112","author":"G Lyratzopoulos","year":"2015","unstructured":"Lyratzopoulos G, Saunders CL, Abel GA, McPhail S, Neal RD, Wardle J, et al. The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers. Br J Cancer. 2015;112(Suppl 1):S35\u201340. https:\/\/doi.org\/10.1038\/bjc.2015.40.","journal-title":"Br J Cancer"},{"issue":"4","key":"1480_CR13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/S1470-2045(12)70041-4","volume":"13","author":"G Lyratzopoulos","year":"2012","unstructured":"Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, Abel GA. Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. Lancet Oncol. 2012;13(4):353\u201365. https:\/\/doi.org\/10.1016\/S1470-2045(12)70041-4.","journal-title":"Lancet Oncol"},{"key":"1480_CR14","doi-asserted-by":"publisher","first-page":"100-2296-2212-2","DOI":"10.1186\/1471-2296-12-100","volume":"12","author":"RP Hansen","year":"2011","unstructured":"Hansen RP, Vedsted P, Sokolowski I, Sondergaard J, Olesen F. General practitioner characteristics and delay in cancer diagnosis. a population-based cohort study. BMC Fam Pract. 2011;12:100-2296-2212-2100.","journal-title":"BMC Fam Pract"},{"issue":"Suppl 2","key":"1480_CR15","doi-asserted-by":"publisher","first-page":"S80","DOI":"10.1038\/sj.bjc.6605396","volume":"101","author":"W Hamilton","year":"2009","unstructured":"Hamilton W. The CAPER studies: five case-control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients. Br J Cancer. 2009;101(Suppl 2):S80\u20136.","journal-title":"Br J Cancer"},{"issue":"614","key":"1480_CR16","doi-asserted-by":"publisher","first-page":"e627","DOI":"10.3399\/bjgp13X671614","volume":"63","author":"BI Scheel","year":"2013","unstructured":"Scheel BI, Ingebrigtsen SG, Thorsen T, Holtedahl K. Cancer suspicion in general practice: the role of symptoms and patient characteristics, and their association with subsequent cancer. Br J Gen Pract. 2013;63(614):e627\u201335. https:\/\/doi.org\/10.3399\/bjgp13X671614.","journal-title":"Br J Gen Pract"},{"key":"1480_CR17","doi-asserted-by":"publisher","unstructured":"Virgilsen LF, Jensen H, Pedersen AF, Zalounina Falborg A, Vedsted P. Patient's worry about cancer and the general practitioner's suspicion of cancer or serious illness: A population-based study in Denmark. Eur J Cancer Care. 2021;30(3):e13411.\u00a0https:\/\/doi.org\/10.1111\/ecc.13411.","DOI":"10.1111\/ecc.13411"},{"issue":"679","key":"1480_CR18","doi-asserted-by":"publisher","first-page":"e80","DOI":"10.3399\/bjgp19X700769","volume":"69","author":"H Jensen","year":"2019","unstructured":"Jensen H, Merrild CH, Moller H, Vedsted P. Association between GPs\u2019 suspicion of cancer and patients\u2019 usual consultation pattern in primary care: a cross-sectional study. Br J Gen Pract. 2019;69(679):e80\u20137. https:\/\/doi.org\/10.3399\/bjgp19X700769.","journal-title":"Br J Gen Pract"},{"issue":"3","key":"1480_CR19","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1136\/bmjqs-2019-009485","volume":"29","author":"D Amelung","year":"2020","unstructured":"Amelung D, Whitaker KL, Lennard D, Ogden M, Sheringham J, Zhou Y, et al. Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study. BMJ Qual Saf. 2020;29(3):198\u2013208. https:\/\/doi.org\/10.1136\/bmjqs-2019-009485.","journal-title":"BMJ Qual Saf"},{"issue":"7 Suppl","key":"1480_CR20","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1177\/1403494811401482","volume":"39","author":"E Lynge","year":"2011","unstructured":"Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;39(7 Suppl):30\u20133. https:\/\/doi.org\/10.1177\/1403494811401482.","journal-title":"Scand J Public Health"},{"issue":"7 Suppl","key":"1480_CR21","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1177\/1403494810387965","volume":"39","author":"CB Pedersen","year":"2011","unstructured":"Pedersen CB. The Danish civil registration system. Scand J Public Health. 2011;39(7 Suppl):22\u20135. https:\/\/doi.org\/10.1177\/1403494810387965.","journal-title":"Scand J Public Health"},{"issue":"7 Suppl","key":"1480_CR22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1177\/1403494810394718","volume":"39","author":"JS Andersen","year":"2011","unstructured":"Andersen JS, Olivarius F, Krasnik A. The Danish National Health Service Register. Scand J Public Health. 2011;39(7 Suppl):34\u20137. https:\/\/doi.org\/10.1177\/1403494810394718.","journal-title":"Scand J Public Health"},{"key":"1480_CR23","doi-asserted-by":"publisher","first-page":"237","DOI":"10.2147\/CLEP.S62855","volume":"6","author":"H Jensen","year":"2014","unstructured":"Jensen H, Torring ML, Larsen MB, Vedsted P. Existing data sources for clinical epidemiology: Danish cancer in primary care cohort. Clin Epidemiol. 2014;6:237\u201346. https:\/\/doi.org\/10.2147\/CLEP.S62855.","journal-title":"Clin Epidemiol"},{"issue":"7","key":"1480_CR24","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1038\/bjc.2012.68","volume":"106","author":"D Weller","year":"2012","unstructured":"Weller D, Vedsted P, Rubin G, Walter FM, Emery J, Scott S, et al. The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer. 2012;106(7):1262\u20137. https:\/\/doi.org\/10.1038\/bjc.2012.68.","journal-title":"Br J Cancer"},{"issue":"7","key":"1480_CR25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009641","volume":"6","author":"D Weller","year":"2016","unstructured":"Weller D, Vedsted P, Anandan C, Zalounina A, Fourkala EO, Desai R, et al. An investigation of routes to cancer diagnosis in 10 international jurisdictions, as part of The International Cancer Benchmarking Partnership: survey development and implementation. BMJ Open. 2016;6(7):e009641-002015-009641. https:\/\/doi.org\/10.1136\/bmjopen-2015-009641.","journal-title":"BMJ Open"},{"key":"1480_CR26","volume-title":"ISCED: International Standard Classification of Education","author":"UNESCO","year":"2014","unstructured":"UNESCO. ISCED: International Standard Classification of Education, vol. 2014; 2014."},{"issue":"6","key":"1480_CR27","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676\u201382. https:\/\/doi.org\/10.1093\/aje\/kwq433.","journal-title":"Am J Epidemiol"},{"key":"1480_CR28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.canep.2019.01.018","volume":"59","author":"L Virgilsen","year":"2019","unstructured":"Virgilsen L, Moller H, Vedsted P. Cancer diagnostic delays and travel distance to health services: a nationwide cohort study in Denmark. Cancer Epidemiol. 2019;59:115\u201322. https:\/\/doi.org\/10.1016\/j.canep.2019.01.018.","journal-title":"Cancer Epidemiol"},{"issue":"2","key":"1480_CR29","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.neo.2017.11.005","volume":"20","author":"MM Koo","year":"2018","unstructured":"Koo MM, Hamilton W, Walter FM, Rubin GP, Lyratzopoulos G. Symptom signatures and diagnostic timeliness in cancer patients: a review of current evidence. Neoplasia. 2018;20(2):165\u201374. https:\/\/doi.org\/10.1016\/j.neo.2017.11.005.","journal-title":"Neoplasia"},{"issue":"dec09 3","key":"1480_CR30","doi-asserted-by":"publisher","first-page":"g7400","DOI":"10.1136\/bmj.g7400","volume":"349","author":"G Lyratzopoulos","year":"2014","unstructured":"Lyratzopoulos G, Wardle J, Rubin G. Rethinking diagnostic delay in cancer: how difficult is the diagnosis? BMJ. 2014;349(dec09 3):g7400. https:\/\/doi.org\/10.1136\/bmj.g7400.","journal-title":"BMJ"},{"issue":"3","key":"1480_CR31","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1038\/bjc.2013.1","volume":"108","author":"G Lyratzopoulos","year":"2013","unstructured":"Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers. Br J Cancer. 2013;108(3):686\u201390. https:\/\/doi.org\/10.1038\/bjc.2013.1.","journal-title":"Br J Cancer"},{"issue":"7","key":"1480_CR32","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","volume":"159","author":"G Zou","year":"2004","unstructured":"Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702\u20136. https:\/\/doi.org\/10.1093\/aje\/kwh090.","journal-title":"Am J Epidemiol"},{"issue":"1","key":"1480_CR33","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2288-3-21","volume":"3","author":"AJ Barros","year":"2003","unstructured":"Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(1):21. https:\/\/doi.org\/10.1186\/1471-2288-3-21.","journal-title":"BMC Med Res Methodol"},{"issue":"7","key":"1480_CR34","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1177\/1403494810382474","volume":"38","author":"O Ekholm","year":"2010","unstructured":"Ekholm O, Gundgaard J, Rasmussen NK, Hansen EH. The effect of health, socio-economic position, and mode of data collection on non-response in health interview surveys. Scand J Public Health. 2010;38(7):699\u2013706. https:\/\/doi.org\/10.1177\/1403494810382474.","journal-title":"Scand J Public Health"},{"issue":"3","key":"1480_CR35","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1038\/bjc.2014.304","volume":"111","author":"LJ Forbes","year":"2014","unstructured":"Forbes LJ, Warburton F, Richards MA, Ramirez AJ. Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer. 2014;111(3):581\u20138. https:\/\/doi.org\/10.1038\/bjc.2014.304.","journal-title":"Br J Cancer"},{"key":"1480_CR36","doi-asserted-by":"publisher","first-page":"189-6963-6969-6","DOI":"10.1186\/1472-6963-9-189","volume":"9","author":"RS Andersen","year":"2009","unstructured":"Andersen RS, Vedsted P, Olesen F, Bro F, Sondergaard J. Patient delay in cancer studies: a discussion of methods and measures. BMC Health Serv Res. 2009;9:189-6963-6969-6189.","journal-title":"BMC Health Serv Res"},{"key":"1480_CR37","doi-asserted-by":"publisher","first-page":"101690","DOI":"10.1016\/j.canep.2020.101690","volume":"65","author":"AZ Falborg","year":"2020","unstructured":"Falborg AZ, Vedsted P, Menon U, Weller D, Neal RD, Reguilon I, et al. Agreement between questionnaires and registry data on routes to diagnosis and milestone dates of the cancer diagnostic pathway. Cancer Epidemiol. 2020;65:101690. https:\/\/doi.org\/10.1016\/j.canep.2020.101690.","journal-title":"Cancer Epidemiol"},{"issue":"6","key":"1480_CR38","doi-asserted-by":"publisher","first-page":"e00328","DOI":"10.1016\/j.heliyon.2017.e00328","volume":"3","author":"K Holtedahl","year":"2017","unstructured":"Holtedahl K, Vedsted P, Borgquist L, Donker GA, Buntinx F, Weller D, et al. Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer. Heliyon. 2017;3(6):e00328.","journal-title":"Heliyon"},{"issue":"698","key":"1480_CR39","doi-asserted-by":"publisher","first-page":"e612","DOI":"10.3399\/bjgp20X712301","volume":"70","author":"CF Smith","year":"2020","unstructured":"Smith CF, Drew S, Ziebland S, Nicholson BD. Understanding the role of GPs\u2019 gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence. Br J Gen Pract. 2020;70(698):e612\u201321. https:\/\/doi.org\/10.3399\/bjgp20X712301.","journal-title":"Br J Gen Pract"},{"issue":"2","key":"1480_CR40","doi-asserted-by":"publisher","first-page":"bjgpopen17X1007","DOI":"10.3399\/bjgpopen17X100761","volume":"1","author":"S Elnegaard","year":"2017","unstructured":"Elnegaard S, Pedersen AF, Sand Andersen R, Christensen RD, Jarb\u00f8l DE. What triggers healthcare-seeking behaviour when experiencing a symptom? Results from a population-based survey. BJGP Open. 2017;1(2):bjgpopen17X100761.","journal-title":"BJGP Open"},{"issue":"Suppl 2","key":"1480_CR41","doi-asserted-by":"publisher","first-page":"S92","DOI":"10.1038\/sj.bjc.6605398","volume":"101","author":"U Macleod","year":"2009","unstructured":"Macleod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer. 2009;101(Suppl 2):S92\u2013s101. https:\/\/doi.org\/10.1038\/sj.bjc.6605398.","journal-title":"Br J Cancer"},{"issue":"7","key":"1480_CR42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0069700","volume":"8","author":"AF Pedersen","year":"2013","unstructured":"Pedersen AF, Hansen RP, Vedsted P. Patient delay in colorectal cancer patients: associations with rectal bleeding and thoughts about cancer. PLoS One. 2013;8(7):e69700. https:\/\/doi.org\/10.1371\/journal.pone.0069700.","journal-title":"PLoS One"},{"issue":"4","key":"1480_CR43","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1038\/sj.bjc.6602714","volume":"93","author":"W Hamilton","year":"2005","unstructured":"Hamilton W, Round A, Sharp D, Peters TJ. Clinical features of colorectal cancer before diagnosis: a population-based case-control study. Br J Cancer. 2005;93(4):399\u2013405. https:\/\/doi.org\/10.1038\/sj.bjc.6602714.","journal-title":"Br J Cancer"},{"issue":"1","key":"1480_CR44","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1471-2296-9-31","volume":"9","author":"J Barrett","year":"2008","unstructured":"Barrett J, Hamilton W. Pathways to the diagnosis of lung cancer in the UK: a cohort study. BMC Fam Pract. 2008;9(1):31. https:\/\/doi.org\/10.1186\/1471-2296-9-31.","journal-title":"BMC Fam Pract"},{"issue":"563","key":"1480_CR45","doi-asserted-by":"publisher","first-page":"441","DOI":"10.3399\/bjgp09X420860","volume":"59","author":"W Hamilton","year":"2009","unstructured":"Hamilton W. Five misconceptions in cancer diagnosis. Br J Gen Pract. 2009;59(563):441\u20135, 447; discussion 446. https:\/\/doi.org\/10.3399\/bjgp09X420860.","journal-title":"Br J Gen Pract"},{"issue":"3","key":"1480_CR46","doi-asserted-by":"publisher","first-page":"225","DOI":"10.4997\/JRCPE.2018.306","volume":"48","author":"ED O'Sullivan","year":"2018","unstructured":"O'Sullivan ED, Schofield SJ. Cognitive bias in clinical medicine. J R Coll Phys Edinb. 2018;48(3):225\u201332. https:\/\/doi.org\/10.4997\/JRCPE.2018.306.","journal-title":"J R Coll Phys Edinb"},{"key":"1480_CR47","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.canep.2017.04.010","volume":"48","author":"MM Koo","year":"2017","unstructured":"Koo MM, von Wagner C, Abel GA, McPhail S, Rubin GP, Lyratzopoulos G. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: evidence from a national audit of cancer diagnosis. Cancer Epidemiol. 2017;48:140\u20136. https:\/\/doi.org\/10.1016\/j.canep.2017.04.010.","journal-title":"Cancer Epidemiol"},{"issue":"9159","key":"1480_CR48","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S0140-6736(99)02142-X","volume":"353","author":"AJ Ramirez","year":"1999","unstructured":"Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999;353(9159):1127\u201331. https:\/\/doi.org\/10.1016\/S0140-6736(99)02142-X.","journal-title":"Lancet"},{"key":"1480_CR49","unstructured":"Danish Cancer Society. English title: Cancer patient's need and experiences with the health care system during cancer diagnostics and treatment. Copenhagen:\u00a0The Danish Cancer Society;\u00a02017."},{"issue":"672","key":"1480_CR50","doi-asserted-by":"publisher","first-page":"e505","DOI":"10.3399\/bjgp18X696233","volume":"68","author":"J Evans","year":"2018","unstructured":"Evans J, Ziebland S, MacArtney JI, Bankhead CR, Rose PW, Nicholson BD. GPs\u2019 understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care. Br J Gen Pract. 2018;68(672):e505\u201311. https:\/\/doi.org\/10.3399\/bjgp18X696233.","journal-title":"Br J Gen Pract"},{"key":"1480_CR51","volume-title":"Danish data protection legislation","author":"Danish Data protection Agency","year":"2020","unstructured":"Danish Data protection Agency. Danish data protection legislation. Copenhagen: Danish Data Protection Agency; 2020. [Available from: https:\/\/www.datatilsynet.dk\/english\/legislation]"},{"key":"1480_CR52","volume-title":"General Data Protection Regulation","author":"Intersoft Consulting","year":"2021","unstructured":"Intersoft Consulting: General Data Protection Regulation; 2021 [Avaliable from: https:\/\/gdpr-info.eu\/]."},{"key":"1480_CR53","volume-title":"Act on Research Ethics Review of Health Research Projects","author":"National Committee on Health Research Ethics","year":"2018","unstructured":"National Committee on Health Research Ethics. Act on Research Ethics Review of Health Research Projects 2018 [Available from: https:\/\/en.nvk.dk\/rules-and-guidelines\/act-on-research-ethics-review-of-health-research-projects]."}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01480-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-021-01480-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01480-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T17:03:15Z","timestamp":1624554195000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01480-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,24]]},"references-count":53,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1480"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01480-2","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,24]]},"assertion":[{"value":"17 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The project is registered in the Record of Processing Activities at the Research Unit for General Practice, Aarhus, in accordance with the General Data Protection Regulation (GDPR) by the EU [] and the Danish Data Protection Act (Act No. 502 of 23 May 2018) []. Patients diagnosed in 2016 gave written consent for us to collect data from their registered GP. For patients diagnosed in 2010, the Danish Health Board gave us permission to obtain data from their registered GP without patient consent in accordance with the Danish Health Act. Approval by the Committee on Health Research Ethics in the Central Denmark Region was not required [] as the data was based solely on registry and questionnaire data. The reporting of the study followed the STROBE guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable for the 2010 cohort. The patient consent obtained for the 2016 cohort included consent for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there are no conflicts of interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"129"}}