BACKGROUND: The positive predictive value (PPV) for cancer of symptoms, signs, and non-diagnostic test results of patients routinely consulting a GP (unselected primary care populations) can help to determine when malignancy should be excluded. Comparisons with other illness indicate that a value of 5% or more may be regarded as highly predictive. AIM: To identify symptoms, signs, and non-diagnostic test results in unselected primary care populations that are highly predictive of cancer. DESIGN OF STUDY: Systematic review. SETTING: Primary care. METHOD: Fourteen bibliographic databases were searched, using terms for primary care, cancer, and predictive values. Reference lists of relevant papers were hand-searched. Data were extracted and the quality of each paper was assessed using predefined criteria, and checked by a second reviewer. RESULTS: Twenty-five studies were identified. PPVs of 5% or more in specific age and sex groups were reported for: rectal bleeding, change in bowel habit, and iron deficiency anaemia and colorectal cancer; haematuria and urological cancer; malignant rectal examination and prostate cancer; haemoptysis and lung cancer; dysphagia and oesophageal cancer; breast lump and breast cancer; and postmenopausal bleeding and gynaecological cancer. CONCLUSION: Robust evidence was found for eight symptoms, signs, and non-diagnostic test results as strongly indicative of cancer for specific age and sex groups in unselected primary care populations. These have the potential to improve the early diagnosis of some cancers in primary care by the use of computer warning flags, improved guidelines, audit, and appraisal.
BACKGROUND: The positive predictive value (PPV) for cancer of symptoms, signs, and non-diagnostic test results of patients routinely consulting a GP (unselected primary care populations) can help to determine when malignancy should be excluded. Comparisons with other illness indicate that a value of 5% or more may be regarded as highly predictive. AIM: To identify symptoms, signs, and non-diagnostic test results in unselected primary care populations that are highly predictive of cancer. DESIGN OF STUDY: Systematic review. SETTING: Primary care. METHOD: Fourteen bibliographic databases were searched, using terms for primary care, cancer, and predictive values. Reference lists of relevant papers were hand-searched. Data were extracted and the quality of each paper was assessed using predefined criteria, and checked by a second reviewer. RESULTS: Twenty-five studies were identified. PPVs of 5% or more in specific age and sex groups were reported for: rectal bleeding, change in bowel habit, and iron deficiency anaemia and colorectal cancer; haematuria and urological cancer; malignant rectal examination and prostate cancer; haemoptysis and lung cancer; dysphagia and oesophageal cancer; breast lump and breast cancer; and postmenopausal bleeding and gynaecological cancer. CONCLUSION: Robust evidence was found for eight symptoms, signs, and non-diagnostic test results as strongly indicative of cancer for specific age and sex groups in unselected primary care populations. These have the potential to improve the early diagnosis of some cancers in primary care by the use of computer warning flags, improved guidelines, audit, and appraisal.
Authors: Christoph Heintze; Dorothea Matysiak-Klose; Thorsten Kröhn; Ute Wolf; Alexander Brand; Christoph Meisner; Imma Fischer; Hartwig Wehrmeyer; Vittoria Braun Journal: Br J Gen Pract Date: 2005-01 Impact factor: 5.386
Authors: Petra Jellema; Daniëlle A W M van der Windt; David J Bruinvels; Christian D Mallen; Stijn J B van Weyenberg; Chris J Mulder; Henrica C W de Vet Journal: BMJ Date: 2010-03-31
Authors: William Hamilton; Robert Lancashire; Debbie Sharp; Tim J Peters; Kk Cheng; Tom Marshall Journal: BMC Med Date: 2009-04-17 Impact factor: 8.775
Authors: M Elisabeth Del Giudice; Emily T Vella; Amanda Hey; Marko Simunovic; William Harris; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: M Elisabeth Del Giudice; Sheila-Mae Young; Emily T Vella; Marla Ash; Praveen Bansal; Andrew Robinson; Roland Skrastins; Yee Ung; Robert Zeldin; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275