Predictive values of colorectal cancer alarm symptoms in the general population: a nationwide cohort study

Rasmussen, Sanne; Haastrup, Peter; Balasubramaniam, Kirubakaran; Elnegaard, Sandra; Christensen, René dePont; Storsveen, Maria Munch; Søndergaard, Jens; Jarbøl, Dorte Ejg

doi:10.1038/s41416-019-0385-x

Cited by 25 publications

(30 citation statements)

References 22 publications

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“…Compared with previous studies on symptom prevalence in the general population, we found that the response rate in our study was comparable or even higher 23,24 . Similar to the findings of this study, we found that the PPVs of gastrointestinal alarm symptoms are low in other DaSC studies 14,15 . Compared with a study on respiratory symptoms in a general population in Britain 25 , we found lower rates of cough and dyspnoea.…”

Section: Discussionsupporting

confidence: 92%

“…Our analyses of the socioeconomic characteristics of eligible individuals aged ≥40 demonstrate that respondents were younger and with higher rates of cohabitation and labour market affiliation, higher educational and income levels, and were more often of Danish ethnicity when compared with non-respondents. The details of the analyses are reported elsewhere 15 . A total of 20% of the respondents stated that they were daily smokers.…”

Section: Resultsmentioning

confidence: 99%

“…The symptoms were selected based on a review of the literature, including national and international guidelines 7,9,17,33 . Other studies derived from DaSC have reported prevalence estimates and predictive values of cancer alarm symptom related to other types of cancer 10,11,[13][14][15] . The respondents were asked whether they had experienced one or more of the specific and nonspecific alarm symptoms: "Have you experienced any of the following sensations, symptoms or discomfort within the past 4 weeks?"…”

Section: Questionnairementioning

confidence: 99%

“…However, such symptoms also often precede common, more benign conditions; on the other hand, many lung cancer patients experience both tumour-specific symptoms such as coughing and dyspnoea as well as systemic, nonspecific symptoms of malignancy such as weight loss and loss of appetite 8,9 . Based on the data from a nationwide survey of symptom experiences in the general population, we have analysed the prevalence of several symptoms [10][11][12][13] as well as the predictive value of gastrointestinal alarm symptoms 14,15 . Lung cancer is one of the most common worldwide, causing high morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…npj Primary Care Respiratory Medicine (2020)15 Published in partnership with Primary Care Respiratory Society UK…”

mentioning

confidence: 99%

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Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Haastrup

Jarbøl

Balasubramaniam

et al. 2020

npj Prim. Care Respir. Med.

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We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Questionnairementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…npj Primary Care Respiratory Medicine (2020)15 Published in partnership with Primary Care Respiratory Society UK…”

mentioning

confidence: 99%

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Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Haastrup

Jarbøl

Balasubramaniam

et al. 2020

npj Prim. Care Respir. Med.

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Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study

Lanas,

Balaguer,

Sánchez‐Luengo

et al. 2023

UEG Journal

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BackgroundColonoscopy is the gold standard for colorectal cancer (CRC) diagnosis and screening, but endoscopy services are usually overburdened. This study aims to investigate the usefulness of fecal hemoglobin (fHb) and calprotectin (FC) for the identification of patients with high probability of CRC who need urgent referral.MethodsIn a multicenter prospective study, we enrolled symptomatic patients referred from primary care for colonoscopy. Prior to bowel preparation, fHb and FC quantitative tests were performed. The diagnostic performance was estimated for each biomarker/combination. We built a multivariable predictive model based on logistic regression, translated to a nomogram and a risk calculator to assist clinicians in the decision‐making process.ResultsThe study included 1224 patients, of whom 69 (5.6%) had CRC. At the fHb cut‐offs of >0 and 10 μg/g, the negative predictive values for CRC were 98.8% (95% confidence interval 97.8%–99.3%) and 98.6% (95%CI 97.7%–99.1%), and the sensitivities were 85.5% (95%CI 75.0%–92.8%) and 79.7% (95%CI 68.3%–88.4%), respectively. When we added the cut‐off of 150 μg/g of FC to both fHb thresholds, the sensitivity of fecal tests improved. In the multivariate logistic regression model, the concentration of fHb was an independent predictor for CRC; age and gender were also independently associated with CRC.ConclusionsfHb and FC are useful as part of a triage tool to identify those symptomatic patients with high probability of CRC. This can be easily applied by physicians to prioritize high‐risk patients for urgent colonoscopy.

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Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines

Booth¹,

Carten²,

D’Souza³

et al. 2022

The Lancet Regional Health - Europe

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Predictive values of colorectal cancer alarm symptoms in the general population: a nationwide cohort study

Cited by 25 publications

References 22 publications

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study

Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study

Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines

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