Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Sarah J Price¹  Niamh Gibson¹  William T Hamilton¹  Angela King²  Elizabeth A Shephard¹ 

[1] University of Exeter Medical School;Policy Research Unit on Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London

关键词: abdominal pain;    cancer;    diagnosis;    general practice;    primary health care;   

DOI  :  10.3399/BJGP.2021.0552

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Quantifying cancer risk in primary care patients with abdominal pain informs 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 (that is, features) indicative of possible cancer.Design and setting This was an observational prospective cohort study using Clinical Practice Research Datalink records with English cancer registry linkage.Method The authors studied 125 793 patients aged ≥40 years with newly reported abdominal pain in primary care between 1 January 2009 and 31 December 2013. The 1-year cumulative incidence of cancer, and the composite 1-year cumulative incidence of cancers with shared additional features, stratified by age and sex are reported.Results With abdominal pain, overall risk was greater in men and increased with age, reaching 3.4% (95% confidence interval [CI] = 3.0 to 3.7, predominantly colorectal cancer 1.9%, 95% CI = 1.6 to 2.1) in men ≥70 years, compared with their expected incidence of 0.88% (95% CI = 0.87 to 0.89). Additional features increased cancer risk; for example, for men, colorectal or pancreatic cancer risk with abdominal pain plus diarrhoea at 60–69 years of age was 3.1% (95% CI = 1.9 to 4.9) predominantly colorectal cancer (2.2%, 95% CI = 1.2 to 3.8).Conclusion60 years age group only with additional features. These results will help direct appropriate referral and testing strategies for patients based on their demographic profile and reporting features. The authors suggest non-invasive strategies first, such as faecal immunochemical testing, with safety-netting in a shared decision-making framework.

【 授权许可】

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