Cancer risk in patients with recurrent or persistent symptoms: a systematic review

Area of Science:

• Oncology
• General Practice
• Epidemiology

Background:

• Most cancer diagnoses follow symptomatic presentation.
• European guidelines prioritize 'alarm' symptoms for GP referrals.
• Approximately 50% of cancer patients do not exhibit 'alarm' symptoms.

Purpose of the Study:

• To systematically review and quantify the positive predictive values (PPVs) of recurrent and persistent symptoms for cancer diagnosis.
• To assess the cancer risk associated with non-'alarm' symptoms.

Main Methods:

• Systematic review of 21 studies.
• Inclusion of data from nearly 200,000 patients.
• Analysis of positive predictive values (PPVs) for 33 recurrent and 22 persistent symptoms.

Main Results:

• Definitions of 'persistent' and 'recurrent' symptoms were inconsistent across studies.
• Recurrent abdominal distension, abdominal pain, and rectal bleeding showed PPVs >3% in younger patients.
• Persistent symptoms were primarily studied in already referred patient populations.

Conclusions:

• Current referral guidelines may overlook significant cancer risk in patients with non-'alarm' symptoms.
• Clearer definitions for symptom recurrence and persistence are needed.
• Prospective validation of cancer risk for non-'alarm' symptoms across all age groups is crucial for improving early cancer diagnosis.