Improving cancer outcomes

With regard to earlier detection of cancer in primary care, I was surprised to see no discussion about the value of recording detailed smoking histories as a way of adding diagnostic information to patients' presenting symptoms. Although this was probably outside the remit of the editorial,1 I have found detailed smoking history recording (total dose and duration of exposure) valuable in my everyday consultations.

Smoking is a major cause of preventable ill-health, especially cancer, and I believe it is vital to record smoking history on primary care computer systems in a way that is both easily visible and searchable. At present, such smoking recording seems to be based on traditional methods that were used in the pre-computer medical records era, and here I specifically refer to the iSoft Premiere software system. In this computer programme the health practitioner can record the type of smoker, an amount for cigarette smoking, and the date smoking stops. This type of data collection is inadequate for modern general practice as it fails to inform the GP of the smoking dose or exposure that an individual patient has received, and it is not computer searchable.

At our surgery, smoking exposure is recorded as ‘smoking pack years’ (smoking 20 cigarettes a day for 1?year is one ‘pack year’) on all ever-smokers with a freetext comment attached to the Read Code, for example, 15 cigarettes a year for 27 years. This has been our recording method for over 5?years and as a GP I find this smoking information useful in thinking about patients' presenting symptoms and in intuitively assessing their cancer risk.

Thus in order to aid smoking-induced disease prediction, I propose that all UK general practice software systems should include ‘smoking pack years’ and ‘duration of smoking’ that should be highly visible and searchable.

• © British Journal of General Practice, January 2011