The risk of oesophago-gastric cancer in symptomatic patients in primary care: a large case-control study using electronic records

Sally A Stapley, Tim J Peters, R. D. Neal, P. W. Rose, F. M. Walter, William T Hamilton*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

49 Citations (Scopus)
282 Downloads (Pure)

Abstract

Background:

Over 15 000 new oesophago-gastric cancers are diagnosed annually in the United Kingdom, with most being advanced disease. We identified and quantified features of this cancer in primary care.

Methods:

Case–control study using electronic primary-care records of the UK patients aged 40 years was performed. Cases with primary oesophago-gastric cancer were matched to controls on age, sex and practice. Putative features of cancer were identified in the year before diagnosis. Odds ratios (ORs) were calculated for these features using conditional logistic regression, and positive predictive values (PPVs) were calculated.

Results:

A total of 7471 cases and 32 877 controls were studied. Sixteen features were independently associated with oesophago-gastric cancer (all P<0.001): dysphagia, OR 139 (95% confidence interval 112–173); reflux, 5.7 (4.8–6.8); abdominal pain, 2.6 (2.3–3.0); epigastric pain, 8.8 (7.0–11.0); dyspepsia, 6 (5.1–7.1); nausea and/or vomiting, 4.9 (4.0–6.0); constipation, 1.5 (1.2–1.7); chest pain, 1.6 (1.4–1.9); weight loss, 8.9 (7.1–11.2); thrombocytosis, 2.4 (2.0–2.9); low haemoglobin, 2.4 (2.1–2.7); low MCV, 5.2 (4.2–6.4); high inflammatory markers, 1.7 (1.4–2.0); raised hepatic enzymes, 1.3 (1.2–1.5); high white cell count, 1.4 (1.2–1.7); and high cholesterol, 0.8 (0.7–0.8). The only PPV >5% in patients 55 years was for dysphagia. In patients <55 years, all PPVs were <1%.

Conclusion:

Symptoms of oesophago-gastric cancer reported in secondary care were also important in primary care. The results should inform guidance and commissioning policy for upper GI endoscopy.

Original languageEnglish
Pages (from-to)25-31
Number of pages7
JournalBritish Journal of Cancer
Volume108
Issue number1
Early online date20 Dec 2012
DOIs
Publication statusPublished - 15 Jan 2013

Keywords

  • diagnosis
  • Oesophago-gastric cancer
  • positive predictive values
  • primary care
  • symptoms

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