title: Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database.
abstract: OBJECTIVE
  To evaluate the association between alarm symptoms and the subsequent diagnosis of cancer in a large population based study in primary care.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  UK General Practice Research Database. Patients 762 325 patients aged 15 years and older, registered with 128 general practices between 1994 and 2000. First occurrences of haematuria, haemoptysis, dysphagia, and rectal bleeding were identified in patients with no previous cancer diagnosis.
  
  
  METHODS
  Positive predictive value of first occurrence of haematuria, haemoptysis, dysphagia, or rectal bleeding for diagnoses of neoplasms of the urinary tract, respiratory tract, oesophagus, or colon and rectum during three years after symptom onset. Likelihood ratio and sensitivity were also estimated.
  
  
  RESULTS
  11.108 first occurrences of haematuria were associated with 472 new diagnoses of urinary tract cancers in men and 162 in women, giving overall three year positive predictive values of 7.4% (95% confidence interval 6.8% to 8.1%) in men and 3.4% (2.9% to 4.0%) in women. After 4812 new episodes of haemoptysis, 220 diagnoses of respiratory tract cancer were made in men (positive predictive value 7.5%, 6.6% to 8.5%) and 81 in women (4.3%, 3.4% to 5.3%). After 5999 new diagnoses of dysphagia, 150 diagnoses of oesophageal cancer were made in men (positive predictive value 5.7%, 4.9% to 6.7%) and 81 in women (2.4%, 1.9 to 3.0%). After 15 289 episodes of rectal bleeding, 184 diagnoses of colorectal cancer were made in men (positive predictive value 2.4%, 2.1% to 2.8%) and 154 in women (2.0%, 1.7% to 2.3%). Predictive values increased with age and were strikingly high, for example, in men with haemoptysis aged 75-84 (17.1%, 13.5% to 21.1%) and in men with dysphagia aged 65-74 (9.0%, 6.8% to 11.7%).
  
  
  CONCLUSIONS
  New onset of alarm symptoms is associated with an increased likelihood of a diagnosis of cancer, especially in men and in people aged over 65. These data provide support for the early evaluation of alarm symptoms in an attempt to identify underlying cancers at an earlier and more amenable stage.
authors.affiliation: Department of General Practice and Primary Care, Division of Health and Social Care Research, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London SE1 6SP. roger.jones@kcl.ac.uk
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
authors.forename: Radoslav
authors.initials: R
authors.lastname: Latinovic
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D003680:Deglutition Disorders / Q000209:etiology; D003951:Diagnostic Errors; D005194:Family Practice / Q000592:standards*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D012002:Rectal Diseases / Q000209:etiology; D006113:United Kingdom