Abstract
Background/significance:
Poorer prognosis for cancer patients in Denmark than in comparable countries has been shown and contributed to the introduction of accelerated diagnostic trajectories for patients suspicious for cancer in 2008. For all types of cancers the National Board of Health developed a manual describing the symptoms that should engender reasonable suspicion of malignancy (“alarm symptoms”) to the general practitioner.
Objectives:
To investigate the evidence in the literature of the predictive value (PPV) placed on the”alarm symptoms” for colon cancer, breast cancer, prostate cancer and lung cancer in a general practice setting.
Methods:
The literature search was done in PubMed. The quality of each paper was assessed using Newcastle-Ottawa Quality Assessment Scale.
Results:
14 original studies were identified. Colon cancer: Concerning ”Rectal bleeding” the PPV is high for patients >60 years (6,6%-21,2%), but much lower in younger age groups. ”Change in bowel habits” and ”Significant general symptoms” are more uncertain (3,5%-8,5%). Breast cancer: ”Palpable suspect tumor” is well supported (8,1%-24%). The predictive value of ”Pitting of the skin”, ”Papil-areola eczema/ulceration” and ”Clinically suspect axillary lymph nodes” was not found in the literature. Prostate cancer: One study shows a high PPV for rectal examination (12%). The value of “Lower urinary tract symptoms” is more uncertain (1,0%-3,0%). PPV of ”Perianal pain” and ”Haemospermia” are not described in the literature. Lung cancer: For “Haemoptysis” a high PPV for elderly patients was found (8,4%-20,4%). PPV of “Cough”, ”Pain in the thorax”, ”Dyspnoea” and ”General symptoms” are small (0,4-1,1%)..
Conclusion:
A few of the “alarm symptoms” show high PPVs. For many symptoms the PPV is not known. To improve diagnostic judgment by GPs and the value of the resource demanding accelerated diagnostic courses more research is needed.
Poorer prognosis for cancer patients in Denmark than in comparable countries has been shown and contributed to the introduction of accelerated diagnostic trajectories for patients suspicious for cancer in 2008. For all types of cancers the National Board of Health developed a manual describing the symptoms that should engender reasonable suspicion of malignancy (“alarm symptoms”) to the general practitioner.
Objectives:
To investigate the evidence in the literature of the predictive value (PPV) placed on the”alarm symptoms” for colon cancer, breast cancer, prostate cancer and lung cancer in a general practice setting.
Methods:
The literature search was done in PubMed. The quality of each paper was assessed using Newcastle-Ottawa Quality Assessment Scale.
Results:
14 original studies were identified. Colon cancer: Concerning ”Rectal bleeding” the PPV is high for patients >60 years (6,6%-21,2%), but much lower in younger age groups. ”Change in bowel habits” and ”Significant general symptoms” are more uncertain (3,5%-8,5%). Breast cancer: ”Palpable suspect tumor” is well supported (8,1%-24%). The predictive value of ”Pitting of the skin”, ”Papil-areola eczema/ulceration” and ”Clinically suspect axillary lymph nodes” was not found in the literature. Prostate cancer: One study shows a high PPV for rectal examination (12%). The value of “Lower urinary tract symptoms” is more uncertain (1,0%-3,0%). PPV of ”Perianal pain” and ”Haemospermia” are not described in the literature. Lung cancer: For “Haemoptysis” a high PPV for elderly patients was found (8,4%-20,4%). PPV of “Cough”, ”Pain in the thorax”, ”Dyspnoea” and ”General symptoms” are small (0,4-1,1%)..
Conclusion:
A few of the “alarm symptoms” show high PPVs. For many symptoms the PPV is not known. To improve diagnostic judgment by GPs and the value of the resource demanding accelerated diagnostic courses more research is needed.
| Original language | Danish |
|---|---|
| Publication date | 2012 |
| Publication status | Published - 2012 |
| Event | International Primary Health Care Reform - YRD - Brisbane, Australia Duration: 6 Mar 2012 → 7 Mar 2012 |
Conference
| Conference | International Primary Health Care Reform - YRD |
|---|---|
| Country/Territory | Australia |
| City | Brisbane |
| Period | 06/03/2012 → 07/03/2012 |
