Cancer incidence and competing mortality risk following 15 presenting symptoms in primary care: a population-based cohort study using electronic healthcare records

Abstract

AbstractObjectivesAssessment 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 analysisData on patients aged 18-99 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, post-menopausal bleed).Time-to-event models were used to estimate outcome-specific hazards for site-specific cancer diagnosis and non-cancer mortality, and used to estimate cumulative incidence up to 12 months following index consultation.ResultsData 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 index.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 individual cancer sites either did not reach the threshold at any age, or reached it only in older patients.ConclusionPatients with new-onset symptoms in primary care often have comparable risk of cancer diagnosis and of non-cancer mortality. A holistic approach to risk assessment that includes the risk of different cancer types alongside mortality risk, especially among older patients, is needed to inform management of symptomatic patients in primary care, particularly for patients with non-organ-specific symptoms.Summary boxWhat is already known on this topicEvidence describing the diagnostic value of symptoms for cancer can help to assess which patients who present to primary care need urgent specialist assessmentCurrent evidence is limited as age is often handled categorically, smoking status is not taken into account and study periods are historical.Further, evidence is concentrated on assessing the risk of specific cancer sites, although the same symptom can be related to cancer of different organs.What this study addsWe present evidence on age-, sex-, and smoking status-specific estimates of risk of cancer of different organs and overall, alongside estimates of non-cancer death.Estimates relate to patients who present with one of 15 possible cancer symptoms, from a relatively recent time period.Certain symptoms such as jaundice and dysphagia are associated with high risk of non-cancer death in older patients.Other symptoms, such as unintended weight loss, fatigue and abdominal pain, are associated with excess risk of a range of different cancers, and such evidence can guide the choice of diagnostic strategies and the design of multi-cancer diagnostic services.