Background: Quantifying cancer risk in primary-care patients reporting abdominal pain would inform diagnostic strategies. Aim: To quantify oesophagogastric, colorectal, liver, pancreatic, ovarian, uterine, kidney and bladder cancer risks associated with newly reported abdominal pain with or without other symptoms, signs or abnormal blood tests (i.e. features) indicative of possible cancer. Design and setting: Observational prospective cohort study using Clinical Practice Research Datalink records with English cancer registry linkage. Methods: Participants (N=125,793) aged ≥40 years had newly reported abdominal pain in primary care during 01/01/2009-31/12/2013. The outcomes were 1-year cumulative incidence of cancer, and the composite 1-year cumulative incidence of cancers with shared additional features, stratified by age and sex. Results: With abdominal pain, overall risk was greater in men and increased with age, reaching 3.4% (95%CI 3.0–3.7%; predominantly colorectal cancer 1.9%, 1.6–2.1%) in men ≥70 years, compared with their expected incidence of 0.88% (0.87%–0.89%). Additional features increased cancer risk; for example, colorectal or pancreatic cancer risk with abdominal pain plus diarrhoea at 60–69 and ≥70, respectively, was 3.1% (1.9–4.9%) and 4.9% (3.7–6.4%), predominantly colorectal cancer (2.2%, 2–3.8% and 3.3%, 2.0–4.9%). Conclusions: Abdominal pain increases intra-abdominal cancer risk nearly fourfold in men aged ≥70, exceeding the 3% threshold warranting investigation. This threshold is surpassed for the over-60s only with additional features. These results help direct appropriate referral and testing strategies for patients based on their demographic profile and reporting features. We suggest non-invasive strategies first, such as faecal immunochemical testing, with safety-netting in a shared decision-making framework.

Background: Non-acute abdominal pain in primary care is diagnostically challenging. Aim: To quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and 9 cancers in adults after newly-recorded abdominal pain in primary care. Design and setting: Observational cohort study of Clinical Practice Research Datalink records. Methods: Participants (n, %male) aged 40-59 (n=59,864, 50.0%), 60-69 (n=29,461, 49.2%) and ≥70 (n=36,468, 36.9%) had newly-recorded abdominal pain during 01/01/2009-31/12/2013. Age- and sex-stratified 1-year cumulative incidence (95% confidence interval) by diagnosis is reported. Results: Most (>70%) participants had no pre-specified diagnoses after newly-recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in men and urinary tract infection in women. The incidence of upper-gastrointestinal problems plateaued at ≥60 years [40-59: men 4.9% (4.6%–5.1%), women 4.0% (3.8%–4.2%); 60-69: men 5.8% (5.4%–6.2%), women 5.4% (5.1%–5.8%)]. Urinary tract infection incidence increased with age [40-59: women 5.1% (4.8%–5.3%), men 1.1% (1.0%–1.2%); ≥70: women 8.0% (7.6%–8.4%), men 3.3% (3.0%–3.6%)]. Diverticular disease incidence rose with age, plateauing at 4.2% (3.9%–4.6%) in men ≥60, increasing to 6.1% (5.8%–6.4%) in women ≥70. Irritable bowel syndrome incidence was higher in women (40-59: 3.0%, 2.8%–3.2%) than men (40-59: 2.1%, 2.0%–2.3%), decreasing with age to 1.3% (1.2%–1.5%) and 0.6% (0.5%–0.8%) at ≥70. Conclusion: We rank the incidence of diagnoses after newly-recorded abdominal pain by sex and age. While abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.

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