Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research DatabaseBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39171.637106.AE (Published 17 May 2007) Cite this as: BMJ 2007;334:1040
- Roger Jones, Wolfson professor of general practice1,
- Radoslav Latinovic, database manager2,
- Judith Charlton, research assistant2,
- Martin C Gulliford, senior lecturer in public health2
- 1Department of General Practice and Primary Care, Division of Health and Social Care Research, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London SE1 6SP
- 2Department of Public Health Sciences, Division of Health and Social Care Research, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London SE1 3QD
- Correspondence to: R Jones
- Accepted 20 March 2007
Objective To evaluate the association between alarm symptoms and the subsequent diagnosis of cancer in a large population based study in primary care.
Design Cohort study.
Setting UK General Practice Research Database.
Patients 762 325 patients aged 15 years and older, registered with 128 general practices between 1994 and 2000. First occurrences of haematuria, haemoptysis, dysphagia, and rectal bleeding were identified in patients with no previous cancer diagnosis..
Main outcome measure Positive predictive value of first occurrence of haematuria, haemoptysis, dysphagia, or rectal bleeding for diagnoses of neoplasms of the urinary tract, respiratory tract, oesophagus, or colon and rectum during three years after symptom onset. Likelihood ratio and sensitivity were also estimated.
Results 11 108 first occurrences of haematuria were associated with 472 new diagnoses of urinary tract cancers in men and 162 in women, giving overall three year positive predictive values of 7.4% (95% confidence interval 6.8% to 8.1%) in men and 3.4% (2.9% to 4.0%) in women. After 4812 new episodes of haemoptysis, 220 diagnoses of respiratory tract cancer were made in men (positive predictive value 7.5%, 6.6% to 8.5%) and 81 in women (4.3%, 3.4% to 5.3%). After 5999 new diagnoses of dysphagia, 150 diagnoses of oesophageal cancer were made in men (positive predictive value 5.7%, 4.9% to 6.7%) and 81 in women (2.4%, 1.9 to 3.0%). After 15 289 episodes of rectal bleeding, 184 diagnoses of colorectal cancer were made in men (positive predictive value 2.4%, 2.1% to 2.8%) and 154 in women (2.0%, 1.7% to 2.3%). Predictive values increased with age and were strikingly high, for example, in men with haemoptysis aged 75-84 (17.1%, 13.5% to 21.1%) and in men with dysphagia aged 65-74 (9.0%, 6.8% to 11.7%).
Conclusion New onset of alarm symptoms is associated with an increased likelihood of a diagnosis of cancer, especially in men and in people aged over 65. These data provide support for the early evaluation of alarm symptoms in an attempt to identify underlying cancers at an earlier and more amenable stage.
Contributors: RJ had the original idea for the study, which was designed by all authors. MCG, RL, and JC extracted and analysed data. RJ drafted the paper, and all authors contributed to the final version. MCG is the guarantor.
Funding: Internal funds, Division of Health and Social Care Research, King's College London.
Competing interests: None declared.
Ethical approval: Scientific and Ethical Advisory Group of the general practice research database (protocol number 785R).
- Accepted 20 March 2007