Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Soriano, Lucía Cea; Soriano‐Gabarró, Montse; Rodrı́guez, Luis A. Garcı́a

doi:10.1002/pds.3877

Cited by 24 publications

(24 citation statements)

References 22 publications

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“…The cancer incidence in THIN is similar to the incidence in the UK Quality Outcomes Framework data (13), and to the UK Office for National Statistics' Cancer Registration Statistics (18,19). Previous studies have assessed the positive predictive values (PPV) of specific cancer diagnosis codes in THIN and found a PPV of 94% for bladder cancer (20) and a PPV of 89% for colorectal cancer (21).…”

Section: Cancermentioning

confidence: 63%

Elevated Vitamin B12 Levels and Cancer Risk in UK Primary Care: A THIN Database Cohort Study

Arendt

Sørensen

Horsfall

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Elevated vitamin B12 levels (B12) are associated with increased short-term cancer risk. However, the implications for early cancer detection in primary care have not been assessed. Methods: Individuals with plasma B12 measurements were sampled from The Health Improvement Network primary care database, UK. Persons with low B12 levels were excluded together with persons with cancer or B12 treatment before date of B12 measurement. Incident cancer was the outcome of interest and was identified through Read codes. Individuals were disaggregated according to plasma B12 levels (unit: pmol/L): 150-600 (reference range values), 601-800, 801-1,000, and >1,000. Results: Among the 757,185 persons who met the inclusion criteria, we identified 33,367 incident cancers during 2,874,059 years of follow-up. We found a higher 1-year cancer risk among the 25,783 (3.4%) persons with elevated B12 levels compared with those with normal B12 levels. After multivariable adjustment for lifestyle factors and social deprivation, persons with B12 >1,000 pmol/L had a 1-year incidence rate ratio of 4.72 (95% confidence interval: 3.99-5.58). The association showed a nonlinear dose-response pattern, and it remained robust in stratified analyses, including when reducing the risk of confounding by indication in subanalyses. The risks were particularly elevated for liver cancer, pancreas cancer, and myeloid malignancies among persons with elevated B12 levels. Conclusions: Elevated plasma B12 levels were associated with a higher 1-year cancer risk than normal B12 levels among persons seen in UK primary care, suggesting that some cancers may affect B12 metabolism. Impact: Elevated B12 may mark occult cancer.

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Section: Cancermentioning

confidence: 63%

Elevated Vitamin B12 Levels and Cancer Risk in UK Primary Care: A THIN Database Cohort Study

Arendt

Sørensen

Horsfall

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…31, 34, 35 The incidence of cancer in THIN was shown to be valid compared to cancer registry data in the entire population of the UK. 54, 55 In an additional study the PPV for incidence PDA identified using Read codes in THIN was 97% based on manual chart review, further supporting the validity of PDA diagnosis in THIN. 56 …”

Section: Discussionmentioning

confidence: 87%

A Clinical Prediction Model to Assess Risk for Pancreatic Cancer Among Patients With New-Onset Diabetes

et al. 2017

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Background and aims Approximately 50% of all patients with pancreatic ductal adenocarcinoma (PDA) develop diabetes mellitus before their cancer diagnosis. Screening individuals with new-onset diabetes might therefore allow earlier diagnosis of PDA. We sought to develop and validate a PDA risk prediction model to identify high-risk individuals among those with new-onset diabetes. Methods We conducted a retrospective cohort study in a population representative database from the UK. Individuals with incident diabetes after the age of 35 and 3 or more years of follow up after diagnosis of diabetes were eligible for inclusion. Candidate predictors consisted of epidemiologic and clinical characteristics available at the time of diabetes diagnosis. Variables with P values below .25 in the univariable analyses were further evaluated using backward stepwise approach. Model discrimination was assessed using receiver operating characteristic curve analysis. Calibration was evaluated using the Hosmer–Lemeshow test. Results were internally validated using a bootstrapping procedure. Results We analyzed data from 109,385 patients with new-onset diabetes. Among them, 390 (0.4%) were diagnosed with PDA within 3 years. The final model (area under the curve, 0.82; 95% CI, 0.75–0.89) included age, body mass index, change in body mass index, smoking, use of proton pump inhibitors and anti-diabetic medications, as well as levels of HbA1C, cholesterol, hemoglobin, creatinine, and alkaline phosphatase. Bootstrapping validation showed negligible optimism. If the predicted risk threshold for definitive PDA screening was set at 1% over 3 years, only 6.19% of the new-onset diabetes population would undergo definitive screening, which would identify patients with PDA with 44.7% sensitivity, 94.0% specificity, and a positive predictive value of 2.6%. Conclusion We developed a risk model based on widely available clinical parameters to help identify patients with new-onset diabetes who might benefit from PDA screening.

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“…Further details about the database are described elsewhere. [ 12 , 13 ] At the time the study was carried out, approximately one fifth of practices contributing to THIN were linked to Hospital Episode Statistics (HES) [ 14 ], thus information from secondary care could be obtained for individuals in these practices.…”

Section: Methodsmentioning

confidence: 99%

New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis: a nested case–control study in UK general practice

et al. 2017

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BackgroundEvidence from clinical trial populations suggests low-dose aspirin reduces the risk of colorectal cancer (CRC). Part of this reduction in risk might be due to protection against metastatic disease.MethodsWe investigated the risk of CRC among new-users of low-dose aspirin (75–300 mg), including risk by stage at diagnosis. Using The Health Improvement Network, we conducted a cohort study with nested case–control analysis. Two cohorts (N = 170,336 each) aged 40–89 years from 2000 to 2009 and free of cancer were identified: i) new-users of low-dose aspirin, ii) non-users of low-dose aspirin, at start of follow-up, matched by age, sex and previous primary care practitioner visits. Patients were followed for up to 12 years to identify incident CRC. 10,000 frequency-matched controls were selected by incidence density sampling where the odds ratio is an unbiased estimator of the incidence rate ratio (RR). RRs with 95% confidence intervals were calculated. Low-dose aspirin use was classified ‘as-treated’ independent from baseline exposure status to account for changes in exposure during follow-up.ResultsCurrent users of low-dose aspirin (use on the index date or in the previous 90 days) had a significantly reduced risk of CRC, RR 0.66 (95% CI 0.60–0.74). The reduction in risk was apparent across all age groups, and was unrelated to dose, indication, gender, CRC location or case-fatality status. Reduced risks occurred throughout treatment duration and with all low-dose aspirin doses. RRs by aspirin indication were 0.71 (0·63–0·79) and 0.60 (0.53–0.68) for primary and secondary cardiovascular protection, respectively. Among cases with staging information (n = 1421), RRs for current use of low-dose aspirin were 0.94 (0.66–1.33) for Dukes Stage A CRC, 0.54 (0.42–0.68) for Dukes B, 0.71 (0.56–0.91) for Dukes C, and 0.60 (0.48–0.74) for Dukes D. After 5 years’ therapy, the RR for Dukes Stage A CRC was 0.53 (0.24–1.19).ConclusionsPatients starting low-dose aspirin therapy have a reduced risk of Stages B–D CRC, suggesting a role for low-dose aspirin in the progression of established CRC; a substantial reduction in the risk of Dukes A CRC may occur after 5 years’ therapy.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3594-9) contains supplementary material, which is available to authorized users.

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Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Cited by 24 publications

References 22 publications

Elevated Vitamin B12 Levels and Cancer Risk in UK Primary Care: A THIN Database Cohort Study

Elevated Vitamin B12 Levels and Cancer Risk in UK Primary Care: A THIN Database Cohort Study

A Clinical Prediction Model to Assess Risk for Pancreatic Cancer Among Patients With New-Onset Diabetes

New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis: a nested case–control study in UK general practice

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