The association between symptoms and bladder or renal tract cancer in primary care: a systematic review.
BACKGROUND
Appropriate selection for further investigation of patients presenting in primary care with symptoms that may indicate cancer is key to early diagnosis.


OBJECTIVE
To quantify the risk of urinary tract cancer in patients presenting in primary care with symptoms that may indicate bladder or renal cancer.


METHODS
Systematic review of studies relating to bladder or renal cancer in primary care.


METHODS
Databases searched were MEDLINE, PreMEDLINE, Embase, the Cochrane Library, Web of Science (SCI and SSCI), and ISI Proceedings from 1980 to August 2014, and PsycINFO (1980-2012) and BioMed Central (inception to 2012) for retrospective, prospective, or case-control diagnostic accuracy studies of symptomatic patients presenting to primary care with one or more symptoms for whom follow-up data were available. The target conditions were bladder or renal cancer. The studies were appraised using the QUADAS-2 tool.


RESULTS
Eleven studies with 3 451 675 patients were included. The positive predictive value (PPV) from meta-analysis of visible haematuria was 5.1% in adult patients. It increased with age and was higher in males. The PPVs of other single symptoms were very low, with the highest non-haematuria PPV being 1.4% for anaemia in males. Fewer data were available on the PPVs of symptom combinations. Generally, these data showed that, with the exception of symptom combinations including haematuria, these were very low.


CONCLUSIONS
The only high-risk feature of bladder/renal cancer in primary care was visible haematuria, and this clearly warrants investigation. However, not all patients with one of these cancers experience haematuria, so a policy restricting investigation to patients with haematuria will inevitably delay the diagnosis in some patients.
National Collaborating Centre for Cancer, Cardiff.
Mia
M
Schmidt-Hansen
National Collaborating Centre for Cancer, Cardiff.
Sabine
S
Berendse
University of Exeter medical School, Exeter.
William
W
Hamilton
D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000175:diagnosis*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000175:diagnosis*
bladder neoplasms; diagnosis; haematuria; primary care; renal neoplasms; symptoms