Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records

Abstract

BackgroundEarly identification of cancer in primary care is important and challenging. This study examined the diagnostic utility of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and plasma viscosity) for cancer diagnosis in primary care.MethodsCohort study of 160,000 patients with inflammatory marker testing in 2014, plus 40,000 untested matched controls, using Clinical Practice Research Datalink (CPRD), with Cancer Registry linkage. Primary outcome was one-year cancer incidence.ResultsPrimary care patients with a raised inflammatory marker have a one-year cancer incidence of 3.53% (95% CI 3.37–3.70), compared to 1.50% (1.43–1.58) in those with normal inflammatory markers, and 0.97% (0.87–1.07) in untested controls. Cancer risk is greater with higher inflammatory marker levels, with older age and in men; risk rises further when a repeat test is abnormal but falls if it normalises. Men over 50 and women over 60 with raised inflammatory markers have a cancer risk which exceeds the 3% NICE threshold for urgent investigation. Sensitivities for cancer were 46.1% for CRP, 43.6% ESR and 49.7% for PV.ConclusionCancer should be considered in patients with raised inflammatory markers. However, inflammatory markers have a poor sensitivity for cancer and are therefore not useful as ‘rule-out’ test.

Study the Role of Combined M2-Pyruvate kinase, Calprotectin and Occult Blood Test as Fecal Biomarkers for Early Detection of Colorectal Cancer

“…There was a significant difference between studied groups regarding platelets, lowest platelet number was detected in cancer group, there was nonsignificant difference between studied groups regarding WBCs, and highest WBCs number was detected in cancer group (8.05±2.3) as shown in table (2) this is in agreement with Morikawa et al [2] who concluded that the FIT relies on the antibodies that bind to the globin, the decomposition of the Hb influences the tool's detection ability, and it is possible that bleeding from proximal colon may lead to an underestimation of the Hb level. Also this agrees with Jessica Watson et al [3] who declared that Cancer risk is greater with higher inflammatory marker levels, with older age and in men; risk rises further when a repeat test is abnormal but falls if it normalizes. Men over 50 and women over 60 with raised inflammatory markers have a cancer risk which exceeds the 3% NICE threshold for urgent investigation.…”

Assessing patients at risk of symptomatic-but-as-yet-undiagnosed cancer in primary care using information from patient records

“…Nicholson et al 6 describe the risk of cancer diagnosis following recorded weight loss in primary care consultations; they estimate this risk to be 1.2% by the end of a 3-month follow-up period, increasing to 1.8% by 12 months. Watson et al 7 examined the risk of cancer following tests for inflammatory markers (such as erythrocyte sedimentation rate, Creactive protein and plasma viscosity) in primary care; they estimate the risk to be 3.5% in patients with raised values by 12 months. Together with other studies estimating the predictive value of different symptoms and pre-diagnostic features, these estimates can support decision making at the clinical encounter and the production of clinical practice guidelines.…”

“…Further, the authors of both commented studies appropriately compared the characteristics of patients with and without recorded weight or recorded inflammatory marker tests, as such analyses can help to assess the generalisability of their findings. 6,7 Unlike information about the presence/absence of symptoms, information about the results of diagnostic tests could additionally allow for appreciation of 'dose-response' associations (e.g. using exact inflammatory marker, 7 or platelet count, 13 values), which could enable further individualising of risk estimates.…”

“…As different cancer sites have heterogeneous associations with the same pre-diagnostic feature, both reviewed studies usefully report data on the cancer site case-mix of patients with either unintended loss of weight or positive inflammatory marker testing. 6,7 Nicholson et al 6 also report that, among patients with unintended weight loss, the greatest cancer site-specific risks relate to pancreatic cancer and cancer of unknown primary, while the risks of either prostate or breast cancer are lower than that in patients without unintended weight loss. Such analyses, of the 'cancer signature' of different pre-diagnostic features, can help to devise cost-efficient investigation strategies, individualising the cascade of specialist diagnostic tests, depending on the presenting symptoms and initial test findings.…”

A Study on Glycated Hemoglobin in Relation to Serum Alkaline Phosphatase, C Reactive Protein and Lipid Profile in Type Ii Diabetes Mellitus

“…There are no signs or symptoms that are specific for an elevated C-reactive protein level, because it is not a specific test. Signs or symptoms, if present, would depend on the underlying inflammatory condition that is the cause of the elevated CRP level (19). CRP is an inflammatory marker which is typically not detected in the blood unless some degree of inflammation is present in the body (20).…”