Elephants rarely get cancer: less than 5% of captive elephants die of cancer, compared to 20% of humans. Elephant genomes have at least 20 copies of the tumour suppressor, p53, which may explain their low cancer rates relative to humans, who have only one copy.
The World Health Organisation defines general practice as providing ‘continuous, comprehensive, co-ordinated and personalised whole-patient care to individuals, families and their communities’. As soon as I completed my clinical training I joined a GP training scheme in Oxfordshire, and have loved being a GP for more than 30 years since then. At its core it’s about being comfortable with being a ‘generalist’ and have some expertise across all clinical conditions, rather than a being a ‘specialist’ with in-depth expertise in one (often very focused) area. When patients first seek help in primary care their problems may be vague or ill-defined- a GP’s expertise lies in working out whether this needs further investigation or referral, or whether the patient can be reassured. One of the most fulfilling parts of being a GP is that we often care for a number of family members over many years. Interestingly, analyses of data from the US, UK and Europe have shown that having more GPs is associated not only with better health outcomes, but also with better patient experience. After working as a GP partner for more than 12 years, I moved to Cambridge and soon met the newly appointed Foundation Chair of General Practice (Ann Louise Kinmonth, also a New Hall alumna) - she encouraged me to consider a clinical academic career. While continuing to work as a part-time GP, I completed a Masters course and then a doctorate. I was fascinated to find that most of the evidence that we used to care for our primary care patients had arisen from less relevant research from specialist care, and that there was a real need for evidence from the primary care setting.
I now lead the Primary Care Cancer Research group at the University of Cambridge- so, it’s never too late for a mid-career change!
While the career of an academic GP can be demanding, it is also very rewarding. I still work as a GP, but only for one day a week. The rest of the week is spent mainly on research, with some under- and post-graduate teaching. My research focuses on developing patient and GP interventions to help diagnose cancer earlier, as there is plenty of evidence that, for most cancers, a timely diagnosis allows curative treatment and better outcomes. Current projects are researching cancers of the skin, oesophagus, stomach, brain, breast and pancreas. I feel very privileged to work alongside world leaders in cancer screening, early detection and treatment on the Cambridge Biomedical campus, and some of my research findings have already led to changes in NHS guidance for patient care.
What’s next? My research will continue to focus on new and cost-effective approaches for preventing and diagnosing cancer.
One example is the impact of technological advances on patient access to health information, and on the monitoring of symptoms and treatments by both patients and GPs. We need more clinical academics in general practice to take this important work forward.
Dr Fiona Walter MA MD FRCGP
Alumna Fiona Walter (New Hall 1976) is Principal Researcher (Reader) in Primary Care Cancer Research at the University of Cambridge. She leads studies investigating cancer prevention, diagnosis and follow-up care, was Fellow of Lucy Cavendish College, Cambridge, and is Honorary Clinical Associate Professor at the University of Melbourne, Australia.