Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records

Shephard, Elizabeth A; Neal, Richard D; Rose, Peter W.; Walter, Fiona M; Hamilton, William

doi:10.3399/bjgp16x683989

Cited by 29 publications

(23 citation statements)

References 17 publications

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“…Datalink (CPRD), mirroring the authors' previous cancer studies. [16][17][18][19][20][21][22][23] The CPRD contains anonymised medical records of patients from participating practices across the UK, representing roughly 8.8% of the population. Information is stored for clinical events such as symptoms, investigations, prescriptions, and diagnoses, together with patient demographics.…”

Section: Resultsmentioning

confidence: 99%

Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records

Shephard

Hamilton

2018

Br J Gen Pract

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BackgroundTesticular cancer incidence has risen over the last two decades and is expected to continue to rise. There are no primary care studies on the clinical features of testicular cancer, with recent National Institute for Health and Care Excellence (NICE) guidance based solely upon clinical consensus.AimTo identify clinical features of testicular cancer and to quantify their risk in primary care patients, with the aim of improving the selection of patients for investigation.Design and settingA matched case–control study in males aged ≥17 years, using Clinical Practice Research Datalink records.MethodPutative clinical features of testicular cancer were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for those aged <50 years.ResultsIn all, 1398 cases were available, diagnosed between 2000 and 2012, with 4956 age-, sex-, and practice-matched controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling (odds ratio [OR] 280, 95% confidence interval [CI] = 110 to 690), testicular lump (OR 270, 95% CI = 100 to 740), and scrotal swelling (OR 170, 95% CI = 35 to 800). The highest PPV for 17–49-year-olds was testicular lump, at 2.5% (95% CI = 1.1 to 5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively.ConclusionTesticular enlargement carries a risk of cancer of 2.5% — close to the current 3% threshold in UK referral guidance. Contrary to traditional teaching, painful testicular enlargement may signify cancer. Some initial hydrocele diagnoses appear to be wrong, with missed cancers, suggesting an ultrasound may be useful when a hydrocele diagnosis is uncertain. These results support the existing NICE guidelines, and help to characterise when an ultrasound should be considered in symptomatic men.

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Section: Resultsmentioning

confidence: 99%

Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records

Shephard

Hamilton

2018

Br J Gen Pract

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“…This study uses a robust data source, the CPRD, which has been used extensively in past studies of cancer risk markers. [11][12][13][14] The use of NCRS data is a further strength, identifying incident cases that may have been unrecorded in the CPRD. Blood counts are electronically transmitted to the CPRD, reducing the risk of recording error.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data

Ankus

Price²,

Ukoumunne

et al. 2018

Family Practice

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“…15 Since then, English and Swedish case-control studies have reported that weight loss is associated with acute and chronic leukaemia and non-metastatic colorectal cancer. 35,36 For some cancer sites there have been no studies on the association with unexpected weight loss in primary care. Our analysis is the first to focus on the association between unexpected weight loss and cancer across all sites.…”

Section: Findings In Contextmentioning

confidence: 99%

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

et al. 2020

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Background We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. Methods This retrospective matched cohort study used cancer registry linked electronic health records from the UK’s Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage. Results In all, 63,973 patients had UWL recorded, of whom 1375 (2.2%) were diagnosed with cancer within 2 years (days-to-diagnosis: mean 181; median 80). Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. The association was greatest in men aged ≥50 years and women ≥70 years. The commonest cancers were pancreas, cancer of unknown primary, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel and renal-tract. The majority were late-stage, but there was some evidence of association with stage II and stage III cancers. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators. Conclusion UWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage.

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Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records

Abstract: BackgroundLeukaemia is the eleventh commonest UK cancer. The four main subtypes have different clinical profiles, particularly between chronic and acute types.

Cited by 29 publications

References 17 publications

Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records

Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records

Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

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