BJGP study highlights eight early symptoms of cancer

Posted on 01 September 2010

Eight clinical features that predict cancer at a high probability rate which could improve early diagnosis have been identified by Keele researchers writing in this month’s British Journal of General Practice (BJGP).  

Dr Mark Shapley and colleagues from Keele University identified eight symptoms or findings with which to predict cancer with sufficient accuracy to oblige urgent investigation in specific age and sex groups, unless individual patient centred reasons exist. These are: rectal bleeding, iron deficiency anaemia, rectal examination suggestive of malignancy, haematuria, haemoptysis, a breast lump, post-menopausal bleeding and dysphagia. 

These symptoms, signs and test results have the potential to improve the early diagnosis of some cancers in primary care.   The authors are calling for more research within the primary care setting to provide GPs with robust methods to help them diagnose cancers much earlier.

Dr Shapley, the lead-author, said: “After carefully analysing twenty-five studies from the UK, US, Netherlands, Belgium, Australia, Denmark and Germany, we identified the eight symptoms.  We recommend research and development of general practice computer systems to produce effective warning flags when the symptoms, signs or test results with a risk of 5% or more from unselected primary care populations are entered for patients within the specified sex and age groups. GPs should audit their management and reflect upon these cases as part of their appraisal to improve quality of care.  There should be more open public debate on the level of risk that triggers a recommendation for referral by a GP.”

Commenting on the study in an editorial also in this month’s BJGP, Dr Kevin Barraclough, a GP from Stroud writes: ‘Unsurprisingly, age ranges are critical to PPV (positive predictive values): iron deficiency anaemia in a 21-year old female is extremely unlikely to be due to colorectal cancer, whereas in a 60-year old male, cancer is likely.’

‘More research in primary care is urgently needed to inform cancer referral guidelines’, adds Dr Barraclough, ‘What we really need are numbers from good primary care studies.  These are surprisingly few and far between.  Shapley et al’s paper is very useful but it does highlight the pressing need for symptom-based research in primary care to inform cancer referral guidelines.’

RCGP Honorary Secretary, Professor Amanda Howe, said: “It’s useful to see these well known ‘red flag’ symptoms and signs validated in primary care research, and reinforces the importance of encouraging patients to discuss worrying symptoms early with their GP. Access and thorough examinations will help early diagnosis while further research gives us more detailed epidemiological thresholds for referral.”



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The study: Positive predictive values of >5% in primary care for cancer: systemic review can be found in the September issue of the British Journal of General Practice. Br J Gen Pract 2010; DOI: 10.3399/bjgp10X515412 (abridged text in print: Br J Gen Pract 2010; 50: 681-688)
Shapley M, Mansell G, Jordan JL, Jordan KP

The editorial: The Predictive value of cancer symptoms in primary care. Br J Gen Pract 2010; DOI: 10.3399/bjgp10X515304. Barraclough K.

The BJGP is published monthly and distributed to over 40,000 RCGP members, associates, and subscribers in more than 40 countries worldwide. Its primary purpose is to publish first-rate, peer reviewed research papers on topics relevant to primary care.

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