Final-year medical students remember only six of at least 20 early warning signs of childhood cancer.

They are especially weak at diagnosing brain cancer‚ the second-most-common form of childhood cancer‚ something described as "particularly concerning" by a research team from the medical school at the University of the Witwatersrand (Wits).

Paediatrician Jennifer Geel said the findings‚ reported in the South African Medical Journal‚ were troubling because early diagnosis was vital in treating cancer and preventing complications such as cognitive and learning difficulties, and irreversible brain damage.

Five-year survival rates of South African children with cancer are poor — about 50%‚ compared with more than 80% in high-income countries — and Geel said underdiagnosis may be partly to blame. Only about 700 cases were reported each year‚ while global guidelines suggested the number should be between 900 and 2,500.

"It has been estimated that two-thirds of South African children with cancer do not reach an appropriate specialist centre‚ and many of the children who present to a paediatric oncology unit do so with advanced disease‚" said Geel.

Early warning signs of childhood cancer‚ such as unexplained bleeding and fever‚ easy bruising‚ fatigue‚ loss of weight and appetite‚ change in balance‚ an enlarging head and aching joints‚ were easily mistaken for common and less severe illnesses.

Geel’s team asked 84 final-year medical students at Wits to recall early warning signs of childhood cancer. They averaged a score of six. Then they presented them with a list of 20 symptoms and asked them to say which were linked to the disease (all of them were). In the second test they averaged 70%.

Geel said: "It may be inferred that medical students are trained to recognise signs and symptoms rather than being able to recall them from memory‚" adding that this may be linked to multiple-choice exams becoming more common.

She said medical schools needed to reassess their methods of training students to recognise childhood cancer.

"Improving survival rates of children with cancer will require a thoughtful‚ multipronged approach‚ and increasing awareness at medical school represents the foundation of this undertaking."

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