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Risk of childhood cancer with symptoms in primary care: a population-based case-control study
Rachel M Dommett1, Theresa Redaniel, Michael C G Stevens
1School of Clinical Sciences, University of Bristol and Department of Paediatric Oncology, Bristol Royal Hospital for Children, UK.
Insights
This study identified 12 key symptoms that significantly increase the risk of childhood cancer, aiding general practitioners (GPs) in early detection. Recognizing these signs, especially with multiple consultations, is crucial for timely diagnosis and intervention.
Area of Science:
- Pediatric Oncology
- General Practice Research
- Epidemiology
Background:
- Existing guidelines for identifying childhood cancer symptoms in primary care lack supporting research.
- General Practitioners (GPs) require evidence-based tools for suspecting cancer in children.
- Early detection of childhood cancer is critical for improving patient outcomes.
Purpose of the Study:
- To identify specific symptoms and signs in primary care that substantially elevate the likelihood of childhood cancer.
- To provide GPs with data to better select children requiring further investigation for cancer.
- To enhance the diagnostic accuracy for pediatric malignancies in a general practice setting.
Main Methods:
- A population-based case-control study was conducted using UK general practice electronic records.
- 1267 children diagnosed with cancer were matched with 15,318 controls from the General Practice Research Database.
- Conditional logistic regression identified clinical features associated with cancer, estimating likelihood ratios and positive predictive values (PPVs).
Main Results:
- Twelve symptoms were associated with a tenfold or greater increase in the prior probability of childhood cancer (PPVs ≥0.04%).
- The most predictive symptoms included pallor, head and neck masses, other masses, lymphadenopathy, abnormal movements, and bruising.
- Combining these symptoms with at least three consultations within three months increased cancer probability significantly.
Conclusions:
- The study identified 12 key features of childhood cancers that increase risk at least tenfold.
- These identified symptoms, particularly when occurring with multiple GP consultations, warrant thorough evaluation.
- The findings support the refinement of diagnostic guidelines for childhood cancer in primary care.
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.
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