Recognizing sinonasal cancer in primary care: a matched case-control study using electronic records.

Area of Science:

• Oncology
• Primary Care Medicine
• Epidemiology

Background:

• Sinonasal cancers are rare in England, with approximately 750 diagnoses annually.
• No specific National Institute for Health and Care Excellence (NICE) referral guidelines exist for these rare cancers.
• There is a lack of published primary care research on sinonasal cancer detection.

Purpose of the Study:

• To identify and quantify clinical features associated with sinonasal cancer in UK primary care patients.
• To analyze the diagnostic value of specific symptoms and investigations in primary care settings.
• To inform potential improvements in early detection strategies for sinonasal cancers.

Main Methods:

• A matched case-control study utilizing the UK Clinical Practice Research Datalink (CPRD) database.
• Inclusion criteria: patients aged 40 years or older diagnosed with sinonasal cancer between 2000 and 2009, with GP consultation in the preceding year.
• Analysis involved conditional logistic regression to assess clinical features and calculate positive predictive values (PPVs).

Main Results:

• Nine symptoms (e.g., nasal mass, head and neck lumps, epistaxis, rhinorrhoea) and one abnormal investigation (raised white cell count) were significantly associated with sinonasal cancer.
• High odds ratios were observed for nasal mass (95) and head and neck lumps (68).
• Combined positive predictive values for epistaxis/rhinorrhoea, epistaxis/sinusitis, and rhinorrhoea/sinusitis were 0.62%.

Conclusions:

• This study is the first in primary care to link epistaxis, sinusitis, and rhinorrhoea to the clinical prodrome of sinonasal cancer.
• While no individual or combined symptom PPVs met the 3% NICE referral threshold, findings can aid clinician judgment for safety-netting and referral.
• Early identification of these clinical features may help reduce the diagnosis of advanced-stage sinonasal cancer.