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 16 January 2018

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News

New onset of alarm symptoms increases diagnosis of cancer

This week's British Medical Journal reports that new onset of alarm symptoms increases the diagnosis of colon cancer.

News image

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Dr Roger Jones and colleagues from England evaluated the association between alarm symptoms and the subsequent diagnosis of cancer in a large population based study in primary care.

The team assessed 762,325 patients aged 15 years and older, registered with 128 general practices between 1994 and 2000.

The team determined first occurrences of hematuria, hemoptysis, dysphagia, and rectal bleeding in patients with no previous cancer diagnosis.

The investigative team measured the first occurrence of hematuria, haemoptysis, dysphagia, or rectal bleeding.

The team measured the positive predictive values of these for diagnoses of neoplasms during 3 years after symptom onset.

Positive predictive value of colon cancer diagnosis after rectal bleeding was 2%
British Medical Journal

The investigators assessed neoplasms of the urinary tract, respiratory tract, esophagus, or colon and rectum.

Likelihood ratio and sensitivity were also estimated.

The investigators found that 11,108 first occurrences of hematuria were associated with 472 new diagnoses of urinary tract cancers in men, and 162 in women.

These rates gave overall 3 year positive predictive values of 7% in men and 3% in women.

The team found that after 4812 new episodes of hemoptysis, 220 diagnoses of respiratory tract cancer were made in men, and 81 in women.

After 5999 new diagnosis of dysphagia, 150 diagnoses of esophageal cancer were made in men, and 81 in women.

The positive predictive value of diagnosing esophageal cancer with a new diagnosis of dysphagia was 7% in men and 2% in women.

After 15,289 episodes of rectal bleeding, 184 diagnoses of colorectal cancer were made in men, and 154 in women.

The positive predictive value of time to first episode of rectal bleeding for a diagnosis of colon cancer was 2% in men and women.

The investigators noted that the predictive values increased with age.

The team observed that the predictive values were strikingly high for men with hemoptysis aged 75 to 84, and in men with dysphagia aged 65 to 74.

Dr Jones' team concluded, "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."

BMJ 2007: 334: 1040
22 May 2007

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