• Alexander Rosendahl, Anet Vanaveski, Liina Pilv-Toom, Jānis Blumfelds, Vija Siliņa, Mette Brekke, Tuomas Koskela, Aurimas Rapalavičius, Hans Thulesius, Peter Vedsted, and Michael Harris.
• Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
• Scand J Prim Health Care. 2025 Jan 21: 181-8.

ObjectiveRelative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics.DesignA survey of GPs using clinical vignettes.SettingGeneral Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden.SubjectsGeneral Practitioners.Outcome MeasuresA regional comparison of GPs' stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%).ResultsOf the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures.ConclusionWhile relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs' reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

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