When should unexpected weight loss warrant further investigation to exclude cancer?
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5271 (Published 23 September 2019) Cite this as: BMJ 2019;366:l5271
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I accept the general thrust of the article , but I question the advice to "patients" as yet another example of ensuring that this latter role should apply even to those who are fit with no other symptoms. We need good evidence on significant outcome benefits , the burden of unnecessary investigation and opportunity costs for the GP. Surely unintended weight loss ( even of the 5% suggested elsewhere in the article) , has not been shown to be always " abnormal” in those with no other symptoms. A common enough occurrence in older patients taking advantage of retirement is to take up fresh activities often becoming absorbed enough to miss meals and coinciding with an age related loss of muscle mass. Those enjoying activity may drive themselves far harder than those just trying to lose weight. A healthier diet with fewer high calorie foods may also be part of this .I recall that my first short term weight loss of > 5% was as a medical registrar also engaged in research with very irregular hours. Perhaps looking at working conditions would have been more appropriate than assuming a remote chance I might have of significant underlying disease. Given a repeat of those circumstances I would still not see seeking medical advice as my first option. With ageing I have learnt that one is rarely free of additional symptoms but have still declined to seek medical advice for any weight loss which I have from time to time and become a "patient" for this.
Competing interests: No competing interests
Thanks for this article but am left in a quandry as keen not to over investigate and medicalise normality but equally not to ''miss'' a person's cancer (assuming diabetes, thyroid disease and other easy to daignose problems are already managed by the primary care services).
So in the scenario of a person with no other symtoms except weight loss what should be the diagnostic sieve used by a GP (if the CCG has commissioned tests and the trust allows them) - and if these don't help who should get the 2ww referral?
So a list of first line tests please, then what to request, if anything, before referring would help GPs who have read this article.
Competing interests: No competing interests
Re: When should unexpected weight loss warrant further investigation to exclude cancer?
We read your recent article with interest, particularly as we have recently analysed the findings of CT chest, abdomen and pelvis (CT CAP) examinations carried out for unexplained weight loss within our Radiology department at the Royal Alexandra Hospital, Paisley.
We identified patients who had CT CAP performed for otherwise asymptomatic weight loss. Of these patients, only a minority were diagnosed with malignancy; non-malignant causes for weight loss were identified in the majority. Of these non-malignant causes the most common were respiratory in nature, with renal disease the second most common. Furthermore, when we assessed a second cohort of patients with weight loss associated with upper gastrointestinal (GI) tract symptoms, a higher proportion of CT CAP examinations revealed a malignant cause than those performed for weight loss alone .
These results emphasise the importance of looking for a wide variety of non-malignant causes in patients presenting with asymptomatic weight loss.
Competing interests: No competing interests