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

Abstract

BackgroundSurvival rates for upper gastrointestinal (GI) cancer are poor since many are diagnosed at advanced stages. Fast track endoscopy has been introduced to prompt diagnosis for patients with alarm symptoms that could be indicative of upper GI cancer. However, these symptoms may represent benign conditions and little is known about the predictive values of alarm symptoms of upper GI cancer in the general population.MethodsThe study is a nationwide cohort study of 60,562 individuals aged 45 years or above randomly selected from the Danish general population. Participants were invited to complete a survey comprising of questions on several symptom experiences, including alarm symptoms for upper GI cancer within the past four weeks. The participants were asked about specific symptoms (repeated vomiting, difficulty swallowing, signs of upper GI bleeding or persistent and recent-onset abdominal pain) and non-specific symptoms (nausea, weight loss, loss of appetite, feeling unwell and tiredness).We obtained information on upper GI cancer diagnosed in a 12-month period after completing the questionnaire from the Danish Cancer Registry. We calculated positive predictive values and positive likelihood ratios for the association between alarm symptom and subsequent upper GI cancer.ResultsA total of 33,040 individuals above 45 years completed the questionnaire, yielding a response rate of 54.6%. Respondents were fairly respresentative of the study sample. During the follow-up period, 18 people were diagnosed with upper GI cancer. The number of incident cancers was similar among eligible non-respondents. Two thirds of the respondents with an upper GI malignancy had experienced one or more alarm symptoms.The positive predictive value for being diagnosed with upper GI cancer after reporting a least one alarm symptom was 0.1% (95% CI:0.0–0.1%). The positive likelihood ratio was 4.4 for specific alarm symptoms and 1.1 for non-specific alarm symptoms.ConclusionsWe found that positive predictive values of alarm symptoms of upper GI cancer experienced in the general population are low. It is important knowledge that despite denoted alarm symptoms even patients with specific alarm symptoms of upper GI cancer have a low risk of being diagnosed with upper GI cancer.

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

“…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.…”

“…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?"…”

“…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.…”

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

“…Other studies have already reported predictive values of gynaecological cancer alarm symptoms 13 and upper gastrointestinal cancer. 14 Parts of the methods described below have therefore been previously described. 7 , 12 , 15 …”

Lifestyle, socioeconomic status and healthcare seeking among women with gynaecological cancer alarm symptoms: a combined questionnaire-based and register-based population study

“…6 7 Most of these guidelines suggest that individuals presenting with symptoms indicative of cancer (alarm symptoms) should be urgently referred to specialised investigative trajectories. Some of the symptoms mentioned in guidelines are commonly occurring and often caused by benign conditions, 8 which poses a clinical challenge due to the rather modest positive predictive values for cancer. On the other hand, most of the cancers must be detected among symptomatic individuals, 4 which justifies the approach with fast-track investigations.…”