A new study published in the American Journal of Surgery highlights the prevalence of emergency department (ED) cancer diagnoses, and is raising crucial questions about patient outcomes in these cases. The study calls for new screening methods to avoid ED cancer diagnoses.

The Montefiore Einstein Center for Cancer Care research focused specifically on stomach cancer which will strike an estimated 28,000 people in the U.S. this year. At Montefiore, 52 percent of stomach cancer cases were diagnosed in the ED and an alarming half of those individuals had stage 4 cancers, which means the cancer has spread to other organs or parts of the body.

“Often there is an assumption that people are using the ED because of inadequate access to a primary care doctor, or lack of insurance,” says senior author Haejin In, M.D., surgical oncologist and assistant professor, Montefiore, Albert Einstein College of Medicine. “Our research shows this may not be the case, and that it is likely the experience of late stage symptoms that drive people to the ED. This suggests our efforts should focus on developing methods for early detection of stomach cancer through  personalized screening programs for high risk individuals.”

Stomach cancers are often diagnosed late because early symptoms such as poor appetite, indigestion, and heartburn, initially may not seem life threatening. Bleeding, weakness, fatigue and pain were commonly listed as the reasons Montefiore patients sought emergency care.

“Worldwide, stomach cancer is a leading cause of death, and environment seems to be a factor,” said Bruce Rapkin, Ph.D., professor of epidemiology & population health at Montefiore and Einstein. “This research shows that screening must include all risk factors including: family history, ethnicity, dietary habits, and  diabetes. This way we can identify who would benefit from advanced screening before they head to the ED with late stage disease.”

There are few studies documenting the prevalence of ED cancer diagnoses in the United States, however data from England backs up the Montefiore findings showing that up to 24 percent of all cancers are identified in the ED. Outcomes for these patients are worse than they would be in primary care settings, because diseases tend to be more advanced. Also, while ED clinicians are experts in life-threatening emergencies they are not cancer specialists who have the most up to date knowledge about cancer care.

As a result of this research, Montefiore is developing new screening criteria using preliminary data from patients at Montefiore and Queens Medical Center. Montefiore is also  partnering with the Alliance for Clinical Trials in Oncology, to evaluate care guidelines for stomach cancer. Researchers are also working with the Emergency Medicine Network to enhance education and communication between emergency departments and cancer specialists across the country.

“The most effective way to fight cancer is to prevent it,” said Dr. In. “This study is the first step to being less reliant on pronounced symptoms to identify and treat stomach cancers earlier than ever before.”