RT Journal Article
SR Electronic
T1 Risk of childhood cancer with symptoms in primary care: a population-based case-control study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e22
OP e29
DO 10.3399/bjgp13X660742
VO 63
IS 606
A1 Rachel M Dommett
A1 Theresa Redaniel
A1 Michael CG Stevens
A1 Richard M Martin
A1 William Hamilton
YR 2013
UL http://bjgp.org/content/63/606/e22.abstract
AB Background Guidelines describing symptoms in children that should alert GPs to consider cancer have been developed, but without any supporting primary-care research.Aim To identify symptoms and signs in primary care that strongly increase the likelihood of childhood cancer, to assist GPs in selection of children for investigation.Design and setting A population-based case-control study in UK general practice.Method Using electronic primary care records from the UK General Practice Research Database, 1267 children aged 0–14 years diagnosed with childhood cancer were matched to 15 318 controls. Clinical features associated with subsequent diagnosis of cancer were identified using conditional logistic regression, and likelihood ratios and positive predictive values (PPVs) were estimated for each.Results Twelve symptoms were associated with PPVs of ≥0.04%, which represents a greater than tenfold increase in prior probability. The six symptoms with the highest PPVs were pallor (odds ratio, OR = 84; PPV = 0.41% (95% confidence interval [CI] = 0.12% to 1.34%), head and neck masses (OR = 17; PPV = 0.30%; 95% CI = 0.10% to 0.84%), masses elsewhere (OR = 22; PPV = 0.11%; 95% CI = 0.06% to 0.20%), lymphadenopathy (OR = 10; PPV = 0.09%; 95% CI = 0.06% to 0.13%), symptoms/signs of abnormal movement (OR = 16; PPV = 0.08%; 95% CI = 0.04% to 0.14%), and bruising (OR = 12; PPV = 0·08%; 95% CI = 0.05% to 0.13%). When each of these 12 symptoms was combined singly with at least three consultations in a 3-month period, the probability of cancer was between 11 and 76 in 10 000.Conclusion Twelve features of childhood cancers were identified, each of which increased the risk of cancer at least tenfold. These symptoms, particularly when combined with multiple consultations, warrant careful evaluation in general practice.