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Research

Microcytosis as a risk marker of cancer in primary care: a cohort study using electronic patient records

Rhian Hopkins, Sarah ER Bailey, William T Hamilton and Elizabeth A Shephard
British Journal of General Practice 2020; 70 (696): e457-e462. DOI: https://doi.org/10.3399/bjgp20X709577
Rhian Hopkins
University of Exeter Medical School, Exeter.
Roles: Medical sciences student
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Sarah ER Bailey
University of Exeter Medical School, Exeter.
Roles: Research fellow
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William T Hamilton
University of Exeter Medical School, Exeter.
Roles: Professor of primary care diagnostics
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Elizabeth A Shephard
University of Exeter Medical School, Exeter.
Roles: Research fellow
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Abstract

Background Microcytosis (smaller than normal red blood cells) has previously been identified as a possible early risk marker for some cancers. However, the role of microcytosis across all cancers has not been fully investigated.

Aim To examine cancer incidence in a cohort of patients with microcytosis, with and without accompanying anaemia.

Design and setting Cohort study of patients aged ≥40 years using UK primary care electronic patient records.

Method The 1-year cancer incidence was compared between cohorts of patients with a mean red cell volume of <85 femtolitres (fL) (low) or 85–101 fL (normal). Further analyses examined sex, age group, cancer site, and haemoglobin values.

Results Of 12 289 patients with microcytosis, 497 had a new cancer diagnosis within 1 year (4.0%, 95% confidence interval [CI] = 3.7 to 4.4), compared with 1465 of 73 150 without microcytosis (2.0%, CI = 1.9 to 2.1). In males, 298 out of 4800 with microcytosis were diagnosed with cancer (6.2%, CI = 5.5 to 6.9), compared with 940 out of 34 653 without (2.7%, CI = 2.5 to 2.9). In females with microcytosis, 199 out of 7489 were diagnosed with cancer (2.7%, CI = 2.3 to 3.1), compared with 525 out of 38 497 without (1.4%, CI = 1.3 to 1.5). In patients with microcytosis but normal haemoglobin, 86 out of 2637 males (3.3%, CI = 2.6 to 4.0) and 101 out of 5055 females (2.0%, CI = 1.6 to 2.4) were diagnosed with cancer.

Conclusion Microcytosis is a predictor of underlying cancer even if haemoglobin is normal. Although a benign explanation is more likely, clinicians in primary care should consider simple testing for cancer on encountering unexplained microcytosis, particularly in males.

  • cancer
  • diagnosis
  • early detection of cancer
  • general practice
  • microcytosis
  • primary health care
  • Received October 3, 2019.
  • Revision requested November 1, 2019.
  • Accepted November 18, 2019.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (696)
British Journal of General Practice
Vol. 70, Issue 696
July 2020
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Microcytosis as a risk marker of cancer in primary care: a cohort study using electronic patient records
Rhian Hopkins, Sarah ER Bailey, William T Hamilton, Elizabeth A Shephard
British Journal of General Practice 2020; 70 (696): e457-e462. DOI: 10.3399/bjgp20X709577

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Microcytosis as a risk marker of cancer in primary care: a cohort study using electronic patient records
Rhian Hopkins, Sarah ER Bailey, William T Hamilton, Elizabeth A Shephard
British Journal of General Practice 2020; 70 (696): e457-e462. DOI: 10.3399/bjgp20X709577
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Keywords

  • cancer
  • diagnosis
  • early detection of cancer
  • general practice
  • microcytosis
  • primary health care

More in this TOC Section

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  • Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment
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