The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records
Open accessAbstract
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.
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Up to 85% of patients with pancreatic ductal adenocarcinoma have cancers that are not surgically resectable when identified.
“Unfortunately, up to 85% of patients have cancers that are not surgically resectable when identified, and over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
From Early detection of pancreatic cancer (2020) · cites this paper as [13]
Over half of patients in the UK are diagnosed with pancreatic ductal adenocarcinoma after a non-specific disease course leading to emergency hospital admission.
“over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
From Early detection of pancreatic cancer (2020) · cites this paper as [13]
Other high-risk groups for pancreatic ductal adenocarcinoma include individuals with new-onset diabetes, modifiable risk factors, non-modifiable risk factors, specific comorbidities, or early symptoms.
“Other high-risk groups have been identified, such as individuals with new-onset diabetes (as discussed above), modifiable risk factors (eg, smoking, obesity), non-modifiable risk factors (eg, age), specific comorbidities (eg, obesity, chronic pancreatitis), or early symptoms (some of which are present for more than 1 year before diagnosis).10,12,13,56”
From Early detection of pancreatic cancer (2020) · cites this paper as [13]
Combining risk factors through cancer decision support tools can reach the 5% risk threshold in some individuals, defining a further group suitable for screening.
“However, by combining these factors through cancer decision support tools, the 5% risk threshold can be reached in some individuals, defining a further group suitable for screening.10,12,13”
From Early detection of pancreatic cancer (2020) · cites this paper as [13]
Patients often show symptoms that suggest pancreatic ductal adenocarcinoma at repeated primary care consultations before diagnosis, but they often encounter delays in the workup process.
“Although patients often show symptoms that suggest pancreatic ductal adenocarcinoma at repeated primary care consultations before diagnosis,12,13,63 they often encounter delays in the workup process.64”
From Early detection of pancreatic cancer (2020) · cites this paper as [13]
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Early detection of pancreatic cancer
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- Authors
- Stapley, S., Peters, T. J., Neal, R. D., Rose, P. W., Walter, F. M., & Hamilton, W.
- Affiliations
- University of Bristol (GB)
- Southmead Hospital (GB)
- Bangor University (GB)
- University of Oxford (GB)
- University of Cambridge (GB)
- Peninsula College of Medicine and Dentistry (GB)
- Corresponding author
- Hamilton, W
- Venue
- British Journal of Cancer
- Published
- 2012-05-22
- Volume
- 106
- Issue
- 12
- Pages
- 1940-1944
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC3388562
- OpenAlex
- W2017898733
- Cited by
- 183
- References
- 55
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 8 · 2023: 26 · 2022: 15 · 2021: 16 · 2020: 13 · 2019: 12 · 2018: 15 · 2017: 13 · 2016: 10 · 2015: 16 · 2014: 13 · 2013: 7 · 2012: 2
- FWCI
- 6.01
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-sa)
- Figshare (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Pancreatic Cancer UK
- National Institute for Health and Care Research (RP-PG-0608-10045)
- Programme Grants for Applied Research
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
- Keywords
- gastroesophageal cancer, cancer risk factors, cancer symptoms, dysphagia, reflux, abdominal pain, epigastric pain, dyspepsia, weight loss, thrombocytosis, anemia, inflammatory markers, upper gastrointestinal endoscopy, primary care, early cancer detection, positive predictive value
- MeSH terms
- Adult, Aged, Aged, 80 and over, Back Pain, Constipation, Diarrhea, Female, Humans, Jaundice, Male, Middle Aged, Nausea, Pancreatic Neoplasms, Primary Health Care, Risk, Vomiting, Weight Loss, Abdominal Pain, Case-Control Studies, Databases as Topic
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