Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records.
BACKGROUND
In the UK, approximately five people are diagnosed with Hodgkin lymphoma (HL) daily. One-tenth of diagnoses are in those aged >75 years.


OBJECTIVE
To establish a symptom profile of HL and quantify their risk in primary care patients aged ≥40 years.


METHODS
Matched case-control study using Clinical Practice Research Datalink patient records.


METHODS
Putative clinical features of HL were identified in the year before diagnosis. Results were analysed using conditional logistic regression and positive predictive values (PPVs) calculated for the consulting population.


RESULTS
Two-hundred and eighty-three patients aged ≥40 years, diagnosed with HL between 2000 and 2009, and 1237 age, sex, and general practice-matched participants were studied. Six features were independently associated with HL: lymphadenopathy (OR 280, 95% confidence interval [CI] = 25 to 3100), head and neck mass not described as lymphadenopathy (OR 260, 95% CI = 21 to 3200), other mass (OR 12, 95% CI = 4.4 to 35), thrombocytosis (OR 6.0, 95% CI = 2.6 to 14), raised inflammatory markers (OR 5.2, 95% CI = 3.0 to 9.0), and low full blood count (OR 2.8, 95% CI = 1.6 to 4.8). Lymphadenopathy per se has a positive predictive value (PPV) of 5.6% for HL in patients aged ≥60 years.


CONCLUSIONS
Consistent with secondary care findings, lymphadenopathy is the clinical feature with the highest risk of HL in primary care and warrants urgent investigation.
University of Exeter Medical School, Exeter.
Elizabeth A
EA
Shephard
North Wales Centre for Primary Care Research, Bangor University, Wrexham.
Richard D
RD
Neal
Department of Primary Care Health Sciences, University of Oxford, Oxford.
Peter W
PW
Rose
Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Fiona M
FM
Walter
University of Exeter Medical School, Exeter.
William T
WT
Hamilton
D000328:Adult; D000367:Age Factors; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
Hodgkin lymphoma; diagnosis; primary health care