ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2015
Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 6 of them syntheses that pooled it.
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Who cites it
44 citing papers in PubMed, 6 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review.BMC cancer · 2020Pooled 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
- Understanding the role of GPs' gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Pooled it
- Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis.BMJ open · 2018Pooled it
- Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Pooled it
- Is real world evidence influencing practice? A systematic review of CPRD research in NICE guidances.BMC health services research · 2016Pooled it
- Emergency diagnosis of multiple myeloma: a SEER-Medicare study.Cancer causes & control : CCC · 2026Article
- Prediagnostic opioid use and survival in multiple myeloma: a nationwide register-based study.Scientific reports · 2026Article
- Article
- Challenges, Difficulties, and Delayed Diagnosis of Multiple Myeloma.Diagnostics (Basel, Switzerland) · 2025Review
- Determining diagnostic delays in Romanian multiple myeloma patients using the Aarhus statement.Frontiers in medicine · 2024Article
- Pre-Referral Primary Care Blood Tests and Symptom Presentation before Cancer Diagnosis: National Cancer Diagnosis Audit Data.Cancers · 2023Article
- Article
- Article
- The incidence of vertebral compression fractures and spinal instability in newly diagnosed multiple myeloma patients.Journal of orthopaedics · 2023Article
- Article
- Patient-reported symptoms and diagnostic journey in Multiple Myeloma.Frontiers in oncology · 2023Article
- Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care.BMJ open · 2021Article
- Improving the diagnostic pathway in patients presenting with acute kidney injury secondary to de novo multiple myeloma: a short report.BMJ open quality · 2021Article
- The effectiveness of the Guy's Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients.British journal of cancer · 2021Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundPatients with myeloma experience the longest diagnostic delays compared with patients with other cancers in the UK; 37% are diagnosed through emergency presentations.
aimTo identify and quantify the risk of myeloma from specific clinical features reported by primary care patients. DESIGN AND
settingMatched case-control study using General Practice Research Database primary care electronic records.
methodPutative clinical features of myeloma were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for the consulting population.
resultsA total of 2703 patients aged ≥40 years, diagnosed with myeloma between 2000 and 2009, and 12 157 age, sex, and general practice-matched controls were identified. Sixteen features were independently associated with myeloma: hypercalcaemia, odds ratio 11.4 (95% confidence interval [CI] = 7.1 to 18), cytopenia 5.4 (95% CI = 4.6 to 6.4), raised inflammatory markers 4.9 (95% CI = 4.2 to 5.8), fracture 3.1 (95% CI = 2.3 to 4.2), raised mean corpuscular volume 3.1 (95% CI = 2.4 to 4.1), weight loss 3.0 (95% CI = 2.0 to 4.5), nosebleeds 3.0 (95% CI = 1.9 to 4.7), rib pain 2.5 (95% CI = 1.5 to 4.4), back pain 2.2 (95% CI = 2.0 to 2.4), other bone pain 2.1 (95% CI = 1.4 to 3.1), raised creatinine 1.8 (95% CI = 1.5 to 2.2), chest pain 1.6 (95% CI = 1.4 to 1.8), joint pain 1.6 (95% CI = 1.2 to 2.2), nausea 1.5 (95% CI = 1.1 to 2.1), chest infection 1.4 (95% CI = 1.2 to 1.6), and shortness of breath 1.3 (95% CI = 1.1 to 1.5). Individual symptom PPVs were generally <1%, although were >10% for some symptoms when combined with leucopenia or hypercalcaemia.
conclusionIndividual symptoms of myeloma in primary care are generally low risk, probably explaining diagnostic delays. Once simple primary care blood tests are taken, risk estimates change. Hypercalcaemia and leucopenia are particularly important abnormalities, and coupled with symptoms, strongly suggest myeloma.
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