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Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)1045-1051
Number of pages7
JournalBritish Journal of Cancer
Issue number11
Early online date24 Apr 2019
DateAccepted/In press - 28 Mar 2019
DateE-pub ahead of print - 24 Apr 2019
DatePublished (current) - 28 May 2019


Early identification of cancer in primary care is important and challenging. This study examined the diagnostic utility of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and plasma viscosity) for cancer diagnosis in primary care.

Cohort study of 160,000 patients with inflammatory marker testing in 2014, plus 40,000 untested matched controls, using Clinical Practice Research Datalink (CPRD), with Cancer Registry linkage. Primary outcome was one-year cancer incidence.

Primary care patients with a raised inflammatory marker have a one-year cancer incidence of 3.53% (95% CI 3.37-3.70), compared to 1.50% (1.43-1.58) in those with normal inflammatory markers, and 0.97% (0.87-1.07) in untested controls. Cancer risk is greater with higher inflammatory marker levels, with older age and in men; risk rises further when a repeat test is abnormal, but falls if it normalises. Men over 50 and women over 60 with raised inflammatory markers have a cancer risk which exceeds the 3% NICE threshold for urgent investigation. Sensitivities for cancer were 46.1% for CRP, 43.6% ESR and 49.7% for PV.

Cancer should be considered in patients with raised inflammatory markers. However, inflammatory markers have a poor sensitivity for cancer and are therefore not useful as ‘rule-out’ test.

    Research areas

  • Diagnosis, cancer, primary health care, electronic health records, C-Reactive protein, erythrocyte sedimentation, biomarkers

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