Risk of childhood cancer with symptoms in primary care: a population-based case-control study

Features of cancer in teenagers and young adults in primary care: a population-based nested case–control study

“…The CPRD is a prospectively gathered, anonymised database that holds longitudinal administrative, clinical and prescribing records (including all consultations and diagnoses) of 11 million patients, from over 600 general practices across the UK (covering approximately 8% of the population; Clinical Practice Research Datalink, 2011). Data from the CPRD has been used in a number of studies to identify and quantify the symptoms of cancer (Hamilton et al , 2009; Shephard et al , 2012; Stapley et al , 2012; Dommett et al , 2012, 2013). …”

“…Libraries of codes representing individual features of possible cancer in TYA were assembled using established methodology (Dommett et al , 2012, 2013). Acne was considered to be unrelated to cancer and was included as a control condition to identify any recording bias (patients with cancer may attend more frequently, giving more opportunities for symptom recording).…”

Why can't we improve the timeliness of cancer diagnosis in children, teenagers, and young adults?

“…If the child also had multiple consultations, this increases to 23/10 000. 12 Although a considerable increase in the likelihood of a cancer diagnosis, for proponents of a "three strikes and refer" policy in young people with alert symptoms, the low predictive value is disappointing and likely to overwhelm services and cause unnecessary anxiety and investigation.…”

Identifying brain tumours in children and young adults

“…For example, of 10 000 children attending their GP with visual symptoms within a three month period, six would be diagnosed as having cancer, but if they had consulted on three or more occasions (for any reason), this number increases to 23. 19 Referral should therefore be carefully considered for children with repeated consultations and a red flag symptom.…”