The risk of pancreatic cancer in symptomatic patients in primary care: a large case–control study using electronic records

Abstract

Background:Over 8000 new pancreatic cancers are diagnosed annually in the UK; most at an advanced stage, with only 3% 5-year survival. We aimed to identify and quantify the risk of pancreatic cancer for features in primary care.Methods:A case–control study using electronic primary care records identified and quantified the features of pancreatic cancer. Cases, aged ⩾40 in the General Practice Research Database, UK, with primary pancreatic cancer were matched with controls on age, sex and practice. Putative features of pancreatic cancer were identified in the year before diagnosis. Odds ratios (OR) were calculated for features of cancer using conditional logistic regression. Positive predictive values (PPV) were calculated for consulting patients.Results:In all, 3635 cases and 16 459 controls were studied. Nine features were associated with pancreatic cancer (all P<0.001 except for back pain, P=0.004); jaundice, OR 1000 (95% confidence interval (CI) 4 302 500); abdominal pain, 5 (4.4, 5.6); nausea/vomiting, 4.5 (3.5, 5.7); back pain, 1.4 (1.1, 1.7); constipation, 2.2 (1.7, 2.8); diarrhoea, 1.9 (1.5, 2.5); weight loss, 15 (11, 22); malaise, 2.4 (1.6, 3.5); new-onset diabetes 2.1 (1.7, 2.5). Positive predictive values for patients aged ⩾60 were <1%, apart from jaundice at 22% (95% CI 14, 52), though several pairs of symptoms had PPVs >1%.Conclusion:Most previously reported symptoms of pancreatic cancer were also relevant in primary care. Although predictive values were small – apart from jaundice – they provide a basis for selection of patients for investigation, especially with multiple symptoms.

Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case–control study using electronic records

“…Testing for association used univariable and multivariable conditional logistic regression, performed in three stages. [17][18][19][20] The variable for hypergammaglobulinaemia was not included in the multivariable analyses as it could be considered an outcome variable rather than an explanatory variable. The first stage, univariable analysis, used a P-value threshold of 0.1 or below to identify candidate variables for multivariable analysis.…”

“…19,20,[22][23][24] This study, the largest reported, provided ample power to identify rare but potentially clinically relevant symptoms of myeloma, and allowed sub-analyses by age. The results are highly likely to be generalisable.…”

Clinical features of kidney cancer in primary care: a case-control study using primary care records

“…The GPRD applies stringent data quality levels on their practices. 14,15 Cases and controls Cases had a record of one of 22 GPRD kidney cancer codes (based on Read Codes and linked to ICD-10 classifications; available from authors) between January 2000 and December 2009 inclusive. All were aged ≥40 years with a minimum of 1 year of data before diagnosis.…”

Risk of uterine cancer in symptomatic women in primary care: case–control study using electronic records

“…5 An association between diabetes and uterine cancer has been reported before and with a similar strength to the association with a raised glucose found in the present study. 24 Finally, a raised platelet count has been reported in primary care studies of lung, and pancreatic cancer, 25,26 as well as secondary care studies of ovarian cancer.…”