Cancer incidence and competing mortality risk following 15 presenting symptoms in primary care: a population-based cohort study using electronic healthcare records
Georgios Lyratzopoulos,
Angela M Wood,
Matthew E Barclay,
Nora Pashayan,
Juliet Usher-Smith,
Antonis Antoniou,
Cristina Renzi,
Hannah Harrison,
Becky White,
Ana Torralbo,
Samantha Hiu Yan Ip,
Jane Lange
Affiliations
Georgios Lyratzopoulos
4 Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, London, UK
Angela M Wood
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
Matthew E Barclay
1 The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
Nora Pashayan
3 University of Cambridge, Cambridge, UK
Juliet Usher-Smith
The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Antonis Antoniou
20 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care and Department of Oncology, University of Cambridge, Cambridge, UK
Cristina Renzi
Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
Hannah Harrison
Breast Biology Research Group, Division of Cancer Sciences, Oglesby Cancer Research Building, The University of Manchester, Manchester, UK
Becky White
Cancer Intelligence, Cancer Research UK, London, UK
Ana Torralbo
Institute of Health Informatics, University College London, London, UK
Samantha Hiu Yan Ip
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
Jane Lange
Cancer Early Detection Advanced Research Center, Oregon Health & Science University, Portland, Oregon, USA
Objectives Assessment of age, sex and smoking-specific risk of cancer diagnosis and non-cancer mortality following primary care consultation for 15 new-onset symptoms.Methods and analysis Data on patients aged 30–99 in 2007–2017 were extracted from a UK primary care database (CPRD Gold), comprising a randomly selected reference group and a symptomatic cohort of patients presenting with one of 15 new onset symptoms (abdominal pain, abdominal bloating, rectal bleed, change in bowel habit, dyspepsia, dysphagia, dyspnoea, haemoptysis, haematuria, fatigue, night sweats, weight loss, jaundice, breast lump and post-menopausal bleed).Time-to-event models were used to estimate outcome-specific hazards for site-specific cancer diagnosis and non-cancer mortality and to estimate cumulative incidence up to 12 months following index consultation.Results Data included 1 622 419 patients, of whom 36 802 had a cancer diagnosis and 28 857 died without a cancer diagnosis within 12 months of the index.The risk of specific cancers exceeded the UK urgent referral risk threshold of 3% from a relatively young age for patients with red flag symptoms. For non-organ-specific symptoms, the risk of cancer at individual sites either did not reach the threshold at any age or reached it only in older patients.Conclusion Patients with new-onset symptoms in primary care often have comparable risks of cancer diagnosis and non-cancer mortality. Non-organ-specific symptoms, in particular, are associated with elevated risk of cancer at multiple different sites. Management of symptomatic patients in primary care should be informed by the risk of different cancer types alongside mortality risk.
