A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer
Open accessAbstract
OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers (BTC) are often diagnosed late and at an advanced stage. Population-based screening programmes do not exist and diagnosis is primarily dependent on symptom recognition. Recently symptom-based cancer decision support tools (CDSTs) have been introduced into primary care practices throughout the UK to support general practitioners (GPs) in identifying patients with suspected PDAC. However, future refinement of these tools to improve their diagnostic accuracy is likely to be necessary. SETTING: The Health Improvement Network (THIN) is a primary care database, which includes more than 11 million electronic patient records, from 562 GP practices in the UK. PARTICIPANTS: All patients with a diagnosis of PDAC or BTC between 2000 and 2010 were included in the study along with six matched controls; 2773 patients with PDAC, 848 patients with BTC and 15,395 controls. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary aim of this study was to determine the early symptom profiles of PDAC and BTC. Secondary aims included comparing early symptom trends between BTC and PDAC, defining symptom onset in PDAC and evaluating trends in routine blood tests nearest to the time of diagnosis. RESULTS: In the year prior to diagnosis, patients with PDAC visited their GP on a median of 18 (IQR 11-27) occasions. PDAC was associated with 11 alarm symptoms and BTC with 8. Back pain (OR 1.33 (95% CI 1.18 to 1.49) p<0.001), lethargy (1.42 (95% CI 1.25 to 1.62) p<0.001) and new onset diabetes (OR 2.46 (95% CI 2.16 to 2.80)) were identified as unique features of PDAC. CONCLUSIONS: PDAC and BTC are associated with numerous early alarm symptoms. CDSTs are therefore likely to be useful in identifying these tumours at an early stage. Inclusion of unique symptoms, symptoms with an early onset and routinely performed blood tests is likely to further improve the sensitivity of these tools.
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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 [10]
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 [10]
Except for jaundice, weight loss, and new-onset diabetes, most individual risk factors or symptoms provide only a modest 1.5-fold to 3-fold increased risk of developing pancreatic ductal adenocarcinoma.
“With the exception of jaundice, weight loss, and new-onset diabetes, which indicate a considerably increased risk, most individual risk factors or symptoms (eg, dyspepsia, bloating, change in bowel habit) only provide a modest (1·5-fold to 3-fold) increased risk of developing pancreatic ductal adenocarcinoma.10,54”
From Early detection of pancreatic cancer (2020) · cites this paper as [10]
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 [10]
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 [10]
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- Authors
- Keane, M. G., Horsfall, L., Rait, G., & Pereira, S. P.
- Affiliations
- University College London (GB)
- Corresponding author
- Pereira, S P
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2014-11
- Volume
- 4
- Issue
- 11
- Pages
- e005720
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4244441
- OpenAlex
- W2112543236
- Cited by
- 81
- References
- 28
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 10 · 2021: 10 · 2020: 7 · 2019: 12 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 6
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Pancreatic Cancer UK (2011 Grant)
- Cancer Research UK
- National Institute for Health and Care Research
- National Cancer Institute (P01 CA84203, P01CA084203)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- pancreatic ductal adenocarcinoma, biliary tract cancer, early symptoms, alarm symptoms, symptom-based diagnosis, back pain, lethargy, new-onset diabetes, routine blood tests, primary care, symptom onset, delayed diagnosis
- MeSH terms
- Aged, Back Pain, Biliary Tract Neoplasms, Female, United Kingdom, Humans, Male, Pancreatic Neoplasms, Abdominal Pain, Comorbidity, Incidence, Case-Control Studies, Carcinoma, Pancreatic Ductal, Early Diagnosis
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