Cancer in Primary Care

Research Overview

Our Cancer in Primary Care Research Group conducts research covering the role of primary care across the cancer continuum (see Figure).

The role of primary care across the cancer continuum. From Emery JD et al Nature Reviews Clinical Oncology 2013

This includes studies on cancer screening, cancer diagnosis and survivorship care. We are interested in the application of risk stratification and risk assessment tools to support more tailored and specific care across the cancer continuum. This includes, for example, our work in colorectal cancer screening and the implementation of fast track pathways for suspected cancer using risk assessment tools in general practice. Our work also examines potential causes of poorer cancer outcomes in specific populations including rural and culturally and lingually diverse communities.  We have recently completed an RCT testing a model of shared care for men with prostate cancer and are developing similar models for other common cancers. We are a highly collaborative group having formed strong collaborations with several local, national and international research groups who share our interests in primary care oncology. This is supported through the Primary Care Collaborative Cancer Clinical Trials Group (PC4) of which Prof Jon Emery is the Director.

PC4- The Primary Care Collaborative Cancer Clinical Trials Group

PC4 is funded by Cancer Australia to support the development of high quality cancer research in primary care. Our Group provides an infrastructure to foster collaboration between researchers, health care practitioners, policy makers and consumers. We provide access to expert advice and resources through our Support Services, and build research capacity with our Training Awards, Workshops and Mentoring Programs. Further information about becoming a member of PC4 and learning more about ways to support your research is provided on the trial group’s website.

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Rebecca Bergin – Honorary Fellow
Rachel Brooks – Research Support Nurse
Sophie Chima – Research Assistant
Deborah de Guingand – National Manager, IC3
Allison Drosdowsky – PhD Candidate
Jon Emery – Herman Chair Of Primary Care Cancer Research, Director, PC4 
Naomi Hudspeth - Research Support Officer
Sally Philip – Program Manager, VCCC Data-Driven Research Hub
Alex Lee - Research Fellow in Cancer Services and Data Science
Jamie Liew – Research Support Officer
Javiera Martinez-Gutierrez – Research Fellow
Kristi Milley – National Manager, PC4
Shakira Milton – Phd Candidate/Research Assistant
Sarah Nagorcka – Communications Coordinator
Sibel Saya – Research Fellow / Trials Coordinator
Isabella Topy - Recruitment Support Officer
Olivia Wawryk – Data Analyst, VCCC Data-Driven Research Hub
Meena Rafiq - Research Fellow
Brent Venning – Academic Registrar
Anna Wood – Project Manager, SMARTscreen
Jianrong Zhang – Phd Candidate
Greg Poynter - Program Manager
Matthew Thoenig - Research Officer
Zoe Siviour - Research Assistant
Raushaan Seychell - Research Assistant
Tarryn Miles -  Research Assistant
Donna Lorenze - Research Assistant
Katerina Piakis - Research Assistant
Floriy La Rocca - Program Manager, Primary Care Trials Unit
Georgia Ramsay - Research Assistant


Prof Jon Emery has a long-standing collaboration with Dr Fiona Walter at the Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge. Together they lead a joint research programme between Melbourne and Cambridge with a focus on cancer risk assessment and early diagnosis – The CamMel Collaboration. Current studies within this collaboration include: The CHEST Trial, CanTest, CRISP, CanRisk and the Melatools programme.

Our other collaborators include:

  • Department of Health Victoria
  • Cancer Council of Australia
  • Victorian Comprehensive Cancer Centre
  • Health and Biomedical Informatics Centre, University of Melbourne
  • Centre for Epidemiology and Biostatistics, University of Melbourne
  • Royal Melbourne Hospital
  • Western Health
  • Peter MacCallum Cancer Centre
  • Department of Public Health and Primary Care, University of Cambridge
  • Department of General Practice, University of Sydney
  • Department of General Practice, Monash University
  • General Practice, University of Western Australia
  • Department of General Practice, Durham University


Our research is funded by the National Health and Medical Research Council (NHMRC), Cancer Australia, Cancer Council Victoria, Department of Health Victoria, Medical Research Future Fund (MRFF) and the BUPA foundation.

Research Publications


Saya S, Emery J, Dowty J, McIntosh J, Winship I, Jenkins M. The impact of a comprehensive risk prediction model for colorectal cancer on a population screening program. JNCI Cancer Spectrum. 2020.

Bergin B, Whitfield K, White V, Milne R, Emery J, Boltong A, Hill D, Mitchell P, Roder D, Walpole E, te Marvelde L, Thomas R. Optimal care pathways: A national policy to improve quality of cancer care and address inequalities in cancer outcomes. Cancer Policy. 2020.

Helsper C, Campbell C, Emery J, Neal R, L Li, Rubin G, van Weert H, Walter F, Weller D, Nekhlyudov L. Cancer has not gone away: A primary care perspective to support a balanced approach for timely cancer diagnosis during COVID‐19. European Journal of Cancer Care. 2020.

Blackmore T, Norman K, Kidd J, Cassim S, Chepulis L, Keenan R, Firth M, Jackson C, Elwood M, Stokes T, Weller D, Emery J, Lawrenson R. Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study. Research Square. 2020.

Bergin R, Emery J, Bollard R, White V. (2020). Comparing Pathways to Diagnosis and Treatment for Rural and Urban Patients With Colorectal or Breast Cancer: A Qualitative Study. The Journal of Rural Health. 2020.

Feletto E, Lew JB, Worthington J, He E, Caruana M, Butler K, Hui H, Taylor N, Banks E, Barclay K, Broun K, Butt A, Carter R, Cuff J, Dessaix A, Ee H, Emery J, Frayling IM, Grogan P, Holden C, Horn C, Jenkins MA, Kench JG, Laaksonen MA, Leggett B, Mitchell G, Morris S, Parkinson B, St John DJ, Taoube L, Tucker K, Wakefield MA, Ward RL, Win AK, Worthley DL, Armstrong BK, Macrae FA, Canfell K. Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia. BMJ Open. 2020.

Jefford M, Koczwara B, Emery J, Thornton-Benko E, Vardy JJ. The important role of general practice in the care of cancer survivors. AJGP. 2020. doi: 10.31128/AJGP-10-19-5133

Walter FM, Pannebakker MP, Barclay ME, Mills K, Saunders CL, Murchie P, Corrie P, Hall P, Burrows N, Emery JD. Effect of a Skin Self-monitoring Smartphone Application on Time to Physician Consultation Among Patients With Possible Melanoma: A Phase 2 Randomized Clinical Trial. JAMA Network Open. 2020. 3;2;e200001 – e200001.

Archer S, de Villiers CB, Scheibl F, Carver T, Hartley S, Lee A, Cunningham AP, Easton DF, McIntosh JG, Emery JD, Tischkovitz M, Antoniou A, Walter FM. Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: A multi-methods study. PLOS One. 2020. 15;3 e0229999.

Walter FM, Emery JD. Further evaluation is required for smartphone-aided diagnosis of skin cancer. (2020). Lancet Digital Health. DOI:

Saunders CL, Kilian B, Thompson DJ, McGeoch LJ, Griffin SJ, Antoniou AC, Emery JD, Walter FM, Dennis J, Xin Yang, Usher-Smith JA. (2020). External validation of risk prediction models incorporating common genetic variants for incident colorectal cancer using UK Biobank. Cancer Prev Res. DOI: 10.1158/1940-6207.CAPR-19-0521


Habgood E, Walter FM, O’Hare E, McIntosh J, McCormack C, Emery JD. (2019) Using an electronic self‐completion tool to identify patients at increased risk of melanoma in Australian primary care. Aus J Derm. 2019.

Nguyen P, McIntosh J, Bickerstaffe A, Maddumarachchi S, Cummings K-L and Emery JD (2019). Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care. BJGP 18 November 2019; bjgp19X706613

Chima S, Reece JC, Milley K, Milton S, McIntosh JG and Emery JD (2019) Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review BJGP 18 November 2019; bjgp19X706745

Signorelli C, Wakefield C, McLoone JK, Fardell J, Jones MJ, Turpin KH, Emery J, Michel G, Downie P, Skeen JE and Cohn R. (2019) Childhood cancer survivorship: barriers and preferences. BMJ Supportive & Palliative Care Published Online 11 Nov 2019 [Epub ahead of print]

McIntosh JG, Minshall J, Saya S, Bickerstaffe A, Hewabandu N, Qama A and Emery JD. (2019) Benefits and harms of selective oestrogen receptor modulators (SERMs) to reduce breast cancer risk: a cross-sectional study of methods to communicate risk in primary care. BJGP 19X706841.

Funston G, Van Melle M, Ladegaard Baun M-L, Jensen H, Helsper C, Emery J, Crosbie EJ, Thompson M, Hamilton W and Walter, FM. (2019) Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines. BMC Cancer 19:1028.

Humphrys E, Walter F, Rubin G, Emery JD, Johnson M, Richards A, Fitzgerald RC, Viswanath YKS, Burt J. (2019) Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study. BJGP Open

Jones OT, Jurascheck LC, van Melle MA, Hickman S, Burrows NP, Hall PN, Emery J, Walter FM (2019) Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open 9:e027529. doi:10.1136/bmjopen-2018-027529

Yee J, Davis GM, Hackett D, Beith JM, Wilcken N, Currow D, Emery J, Phillips J, Martin A, Hui R, Harrison M, Segelov E, Kilbreath SL. (2019) Physical activity for symptom management in women with metastatic breast cancer: a randomised feasibility trial. Journal of Pain and Symptom Management doi: 10.1016/j.jpainsymman.2019.07.022. [Epub ahead of print]

McGeoch L, Saunders CL, Griffin SJ, Emery JD, Walter FM, Thompson DJ, Antoniou AC, Usher-Smith JA. (2019) Risk prediction models for colorectal cancer incorporating common genetic variants: a systematic review. Cancer Epidemiology Biomarkers and Prevention doi: 10.1158/1055-9965.EPI-19-0059. [Epub ahead of print]

Renzi C, Kaushal A, Emery J, Hamilton W, Neal R, Rachet B, Rubin G, Singh H, Walter FM, Wit NJ, Lyratzopoulos G (2019). Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms. Nature Reviews Clinical Oncology 2019; 16; 746-61.

Gabriel MG, Wakefield CE, Vetsch J, Karpelowsky JS, Darlington A-S E, Cohn RJ, Signorelli C, ANZCHOG Survivorship Study Group, Alvaro F, Corbett R, Downie P, Egan K, Ellis S, Emery J, Fardell J, Foreman T, Gabriel M, Girgis A, Graham K, Johnston K, Jones J, Lockwood L, Maguire A, McCarthy M, McLoone J, Mechinaud F, Molloy S, Moore L, Osborn M, Skeen J, Tapp H, Till T, Truscott J, Turpin K, Williamson J, Walwyn T, Yallop K (2019). Paediatric surgery for childhood cancer: Lasting experiences and needs of children and parents. European Journal of Cancer Care e13116.

Licqurish S, Cook O, Pattuwage L, Saunders C, Jefford M, Koczwara B, Johnson C, Emery J. (2019). Tools to facilitate communication during physician-patient consultations in cancer care. An overview of systematic reviews. CA Cancer J Clin. 2019. Doi 10.3322/caac.21573.

Walter FM, Thompson MJ, Wellwood I, Abel GA, Hamilton W, Johnson M, Lyratzopoulos G, Messenger MP, Neal RD, Rubin G, Singh H, Spencer A, Sutton S, Vedsted P, Emery JD. (2019) Evaluating diagnostic strategies for early detection of cancer: the CanTest framework. BMC Cancer 19 (1):586

Jenkins MA, Win AK, Dowty JG, MacInnis RJ, Makalic E, Schmidt DF, Dite GS, Kapuscinski M, Clendenning M, Rosty C, Winship IM, Emery JD, Saya S, Macrae FA, Ahnen DJ, Duggan D, Figueiredo JC, Lindor NM, Haile RW, Potter JD, Cotterchio M, Gallinger S, Newcomb PA, Buchanan DD, Casey G, Hopper JL. (2019) Ability of known susceptibility SNPs to predict colorectal cancer risk for persons with and without a family history. Familial Cancer doi: 10.1007/s10689-019-00136-6. [Epub ahead of print]

Harty EC, McIntosh JG, Bickerstaffe A, Hewabandu N, Emery JD. (2019) The CRISP-P study: feasibility of a self-completed colorectal cancer risk prediction tool in primary care. Family Practice doi: 10.1093/fampra/cmz029. [Epub ahead of print]

Signorelli C, Wakefield CE, Fardell JE, Foreman T, Johnston KA, Emery J, Thornton-Benko E, Girgis A, Lie HC, Cohn RJ, Anzchog Survivorship Study Group (2019) The role of primary care physicians in childhood cancer survivorship care: multiperspective interviews. The Oncologist 24 (5), 710-719

Bergin RJ, Emery J, Bollard R, White V. (2019) Research evidence supports cancer policymaking but is insufficient for change: Findings of key informant interviews from five countries. Health Policy 123 (6) 572-581

Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM. (2019) Dermoscopy use in UK primary care: a survey of GP s with a special interest in dermatology. Journal of the European Academy of Dermatology and Venereology doi: 10.1111/jdv.15614

Canaway R, Boyle DIR, Manski‐Nankervis JAE, Bell J, Hocking JS, Clarke K, Clark M, Gunn JM Emery JD. (2019) Gathering data for decisions: best practice use of primary care electronic records for research. Medical Journal of Australia 210 (6), S12-S16

Neal RD, Sun F, Emery JD, Callister ME. Lung cancer. BMJ 2019.

Philip J, Collins A, Le B, Sundararajan V, Brand C, Hanson S, Emery J, et al. (2019) A randomised phase II trial to examine feasibility of standardised, early palliative (STEP) care for patients with advanced cancer and their families. Pilot and Feasibility Studies 5 (1): 44

Pannebakker MM, Mills K, Johnson M, Emery JD, Walter FM. (2019) Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation. BJGP Open 19 March 2019 bjgpopen18X101635. doi:10.3399/

Kummer S, Walter FM, Chilcot J, Emery J, Sutton S, Scott SE. (2019) Do cognitive heuristics underpin symptom appraisal for symptoms of cancer? A secondary qualitative analysis across seven cancers. Psycho‐Oncology 2019;1–7. doi: 10.1002/pon.5049

Emery J (2019) Preparing for the genomics era. Aust J of Gen Pract 48 (3): 85

Delatycki MB, Laing NG, Moore SJ, Emery J, Archibald AD, Massie J, et al. (2019) Preconception and antenatal carrier screening for genetic conditions: 'The critical role of general practitioners' Aust J of Gen Pract 48 (3): 106

Keogh LA, Steel E, Weideman P, Butow P, Collins IM, Emery JD et al. (2019) Consumer and clinician perspectives on personalising breast cancer prevention information. The Breast 43: 39-47

Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza d, Habgood E, Kutzer Y, Barnes DJ, Murchie P. (2019) The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax, thoraxjnl-2018-212506 [Epub ahead of print]


Lo LL, Collins IM, Bressel M, Butow P, Emery J, Keogh L, Weideman P, Steel E, Hopper JL, Trainer AH, Mann GB, Bickerstaffe A, Antoniou AC, Cuzick J, Phillips KA. (2018) The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing. JMIR Formative Research 2(2): e24. doi: 10.2196/formative.9935.

Jenkins MA, Ait Ouakrim D, Boussioutas A, Hopper JL, Ee HC, Emery JD, Macrae FA, Chetcuti A, Wuellner L, St John DJB. Revised Australian national guidelines for colorectal cancer screening: family history (2018) Med J Aust. 2018;209(10):455-460.

Lew JB, St John DJB, Macrae FA, Emery JD, Ee HC, Jenkins MA, He E, Grogan P, Caruana M, Greuter MJE, Coupé VMH, Canfell K. Benefits, Harms, and Cost-Effectiveness of Potential Age Extensions to the National Bowel Cancer Screening Program in Australia (2018) Cancer Epidemiol Biomarkers Prev. doi: 10.1158/1055-9965.EPI-18-0128.

Humphrys E, Burt J, Rubin G, Emery JD, Walter FM. The influence of health literacy on the timely diagnosis of symptomatic cancer: A systematic review. Eur J Cancer Care (Engl). 2018 Oct 16:e12920. doi: 10.1111/ecc.12920.

Coxon D, Campbell C, Walter FM, Scott SE, Neal RD, Vedsted P, Emery J, Rubin G, Hamilton W, Weller D. (2018) The Aarhus statement on cancer diagnostic research: turning recommendations into new survey instruments. BMC Health Services Research, 18(1):677. doi: 10.1186/s12913-018-3476-0

Walker JG, Macrae F, Winship I, Oberoi J, Saya S, Milton S, Bickerstaffe A, Dowty JG, De Abreu Lourenço R, Clark M, Galloway L, Fishman G, Walter FM, Flander L, Chondros P, Ait Ouakrim D, Pirotta M, Trevena L, Jenkins MA, Emery JD. (2018) The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial. Trials, 19(1):397. doi: 10.1186/s13063-018-2764-7

Mazza D, Lin X, Walter FM, Young JM, Barnes DJ, Mitchell P, Brijnath B, Martin A, Emery JD. (2018) The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds. BMC Cancer, 18(1):754. doi: 10.1186/s12885-018-4671-4

Stanciu MA, Law R-J, Nafees S, Hendry M, Yeo ST, Hiscock J, Lewis R, Edwards RT, Williams NH, Brain K, Brocklehurst P, Carson-Stevens A, Dolwani S, Emery J, Hamilton W, Hoare Z, Lyratzopoulos G, Rubin G, Smits S, Vedsted P, Walter F, Wilkinson C, Neal RD. (2018) Development of an intervention to expedite cancer diagnosis through primary care: a protocol. BJGP Open 2018; doi: 10.3399/bjgpopen18X101595

Signorelli C, Wakefield CE, Fardell JE, Foreman T, Johnston KA, Emery J, Thornton-Benko E, Girgis A, Lie HC, Cohn RJ, Anzchog Survivorship Study Group. (2018) The Role of Primary Care Physicians in Childhood Cancer Survivorship Care: Multiperspective Interviews. The Oncologist, Aug 31. doi: 10.1634/theoncologist.2018-0103

Dillon M, Flander L, Buchanan DD, Macrae FA, Emery JD, Winship IM, Boussioutas A, Giles GG, Hopper JL, Jenkins MA, Ait Ouakrim D. (2018) Family history-based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios. PLoS Med, Aug 16;15(8): e1002630. doi: 10.1371/journal.pmed.1002630


Wilson, E.C.F., et al., Expert Elicitation of Multinomial Probabilities for Decision-Analytic Modeling: An Application to Rates of Disease Progression in Undiagnosed and Untreated Melanoma. Value Health, 2018. 21(6): p. 669-676.

Walker, J.G., et al., The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial. Trials, 2018. 19(1): p. 397.

Signorelli, C., et al., Recruiting primary care physicians to qualitative research: Experiences and recommendations from a childhood cancer survivorship study. Pediatr Blood Cancer, 2018. 65(1).

Signorelli, C., et al., The Role Of Primary Care Physicians in Childhood Cancer Survivorship Care: Multiperspective Interviews. Oncologist, 2018.

Rubin, G., et al., Reimagining the diagnostic pathway for gastrointestinal cancer. Nat Rev Gastroenterol Hepatol, 2018. 15(3): p. 181-188.

Nair-Shalliker, V., et al., Factors associated with prostate specific antigen testing in Australians: Analysis of the New South Wales 45 and Up Study. Sci Rep, 2018. 8(1): p. 4261.

Mazza, D., et al., The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds. BMC Cancer, 2018. 18(1): p. 754.

Lew, J.B., et al., Evaluation of the benefits, harms and cost-effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia. Int J Cancer, 2018. 143(2): p. 269-282.

Lew, J.B., et al., Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia. Cancer Epidemiol Biomarkers Prev, 2018.

Kim, G.Y., et al., The CRISP-Q study: Communicating the risks and benefits of colorectal cancer screening. Aust J Gen Pract, 2018. 47(3): p. 139-145.

Emery, J.D., et al., The Improving Rural Cancer Outcomes Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia. Br J Cancer, 2018. 118(6): p. e8.

Dillon, M., et al., Family history-based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios. PLoS Med, 2018. 15(8): p. e1002630.

Croager, E.J., et al., Find Cancer Early: Evaluation of a Community Education Campaign to Increase Awareness of Cancer Signs and Symptoms in People in Regional Western Australians. Front Public Health, 2018. 6: p. 22.


Walker JG, Bickerstaffe A, Hewabandu N, Maddumarachchi S, Dowty JG, Jenkins M, Pirotta M, Walter FM, Emery JD. (2017). The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care. BMC Medical Informatics and Decision Making, 17(1), 1-11. DOI: 10.1186/s12911-017-0407-7

Emery J, Saya S. (2017). Applying genomics to tailor colorectal cancer screening. EuroDigest, 1(4) 20-21


van Die MD, Bone KM, Emery J, Williams SG, Pirotta MV, Paller CJ. Phytotherapeutic interventions in the management of biochemically recurrent prostate cancer: A systematic review of randomised trials. BJU Int. 2016 April; 117 (4):17-34.

Usher-Smith JA, Walter FM, Emery JD, Win AK, Griffin SJ. Risk Prediction Models for Colorectal Cancer: A Systematic Review. Cancer Prevention Research. 2016 Jan; 9(1):13-26.

Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. British Journal of Cancer. 2015 Mar; 112:S92-S107.

Walker JG, Licqurish S, Chiang PPC, Pirotta M, Emery JD. Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials. Annals of Family Medicine. 2015 Sep; 13(5):480-489.

Emery JD, Shaw K, Williams B, Mazza D, Fallon-Ferguson J, Varlow M, Trevena LJ. The role of primary care in early detection and follow-up of cancer. Nature Reviews Clinical Oncology. 2014 Nov; 11: 38-4