ArticleBMJ (Clinical research ed.)2007
Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database.
Article in BMJ (Clinical research ed.), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 128 papers, 12 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
128 citing papers in PubMed, 12 syntheses or guidelines pooled it, 250 citations in OpenAlex.
- The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review.BMC cancer · 2022Pooled it
- Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis.Health technology assessment (Winchester, England) · 2020Pooled it
- Pooled it
- ACG and CAG Clinical Guideline: Management of Dyspepsia.The American journal of gastroenterology · 2017Guideline
- Lung cancer in symptomatic patients presenting in primary care: a systematic review of risk prediction tools.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Pooled it
- Is real world evidence influencing practice? A systematic review of CPRD research in NICE guidances.BMC health services research · 2016Pooled it
- Risk prediction models for colorectal cancer in people with symptoms: a systematic review.BMC gastroenterology · 2016Pooled it
- The association between symptoms and bladder or renal tract cancer in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Pooled it
- Systematic review of clinical features of suspected colorectal cancer in primary care.Canadian family physician Medecin de famille canadien · 2014Pooled it
- Systematic review of guidelines for the management of suspected lung cancer in primary care.Canadian family physician Medecin de famille canadien · 2014Pooled it
- The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Pooled it
- Positive predictive values of ≥5% in primary care for cancer: systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2010Pooled it
- Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A Cluster Randomized Controlled Trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2015Trial
- A geographical cluster randomised stepped wedge study of continuing medical education and cancer diagnosis in general practice.Implementation science : IS · 2014Trial
- Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm.The British journal of general practice : the journal of the Royal College of General Practitioners · 2012Trial
- Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm.The British journal of general practice : the journal of the Royal College of General Practitioners · 2012Trial
- Patient-reported symptoms in predicting the subsequent progression of chronic health conditions among childhood cancer survivors.Communications medicine · 2026Article
- Clinical assessment of recurrent cancer: a Danish cohort study in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Early Symptom Warnings and Long-Term Health Conditions in Childhood Cancer Survivors: Insights from the Childhood Cancer Survivor Study and St. Jude Lifetime Cohort Study.Research square · 2025Article
- Development and external validation of prediction algorithms to improve early diagnosis of cancer.Nature communications · 2025Article
68 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the association between alarm symptoms and the subsequent diagnosis of cancer in a large population based study in primary care.
designCohort study.
settingUK General Practice Research Database. Patients 762 325 patients aged 15 years and older, registered with 128 general practices between 1994 and 2000. First occurrences of haematuria, haemoptysis, dysphagia, and rectal bleeding were identified in patients with no previous cancer diagnosis.
main outcome measurePositive predictive value of first occurrence of haematuria, haemoptysis, dysphagia, or rectal bleeding for diagnoses of neoplasms of the urinary tract, respiratory tract, oesophagus, or colon and rectum during three years after symptom onset. Likelihood ratio and sensitivity were also estimated.
results11.108 first occurrences of haematuria were associated with 472 new diagnoses of urinary tract cancers in men and 162 in women, giving overall three year positive predictive values of 7.4% (95% confidence interval 6.8% to 8.1%) in men and 3.4% (2.9% to 4.0%) in women. After 4812 new episodes of haemoptysis, 220 diagnoses of respiratory tract cancer were made in men (positive predictive value 7.5%, 6.6% to 8.5%) and 81 in women (4.3%, 3.4% to 5.3%). After 5999 new diagnoses of dysphagia, 150 diagnoses of oesophageal cancer were made in men (positive predictive value 5.7%, 4.9% to 6.7%) and 81 in women (2.4%, 1.9 to 3.0%). After 15 289 episodes of rectal bleeding, 184 diagnoses of colorectal cancer were made in men (positive predictive value 2.4%, 2.1% to 2.8%) and 154 in women (2.0%, 1.7% to 2.3%). Predictive values increased with age and were strikingly high, for example, in men with haemoptysis aged 75-84 (17.1%, 13.5% to 21.1%) and in men with dysphagia aged 65-74 (9.0%, 6.8% to 11.7%).
conclusionNew onset of alarm symptoms is associated with an increased likelihood of a diagnosis of cancer, especially in men and in people aged over 65. These data provide support for the early evaluation of alarm symptoms in an attempt to identify underlying cancers at an earlier and more amenable stage.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.