ArticleBMJ open2023
Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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15 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Life Course Trajectories of Body Mass Index and Risk of Cancer in Adulthood: Systematic Review and Meta-Analysis.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026Pooled it
- Using large language models to identify prediagnostic clinical features of ovarian cancer from healthcare records: a population-based case-control study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Immune Regulation and the Role of Extracellular Vesicles in Non-Small Cell Lung Cancer: Biological Mechanisms and Therapeutic Perspectives.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Extracting Cardiorespiratory Symptoms From Clinical Notes Using Open-Weight Large Language Models: Method Development and Validation Study.JMIR cardio · 2026Article
- Awareness of Lung Cancer Signs and Symptoms, Risk Factors, and Screening in Jordan: Cross-Sectional Study.JMIR cancer · 2026Article
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- Secure and interpretable lung cancer prediction model using mapreduce private blockchain federated learning and XAI.Scientific reports · 2025Article
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- Predicting the Future by Studying the Past for Patients With Cancer Diagnosed in the Emergency Department.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Article
- The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit.British journal of cancer · 2024Article
- Development and Validation of Case-Finding Algorithms for Digestive Cancer in the Spanish Healthcare Database BIFAP.Journal of clinical medicine · 2024Article
- Prevalence of pre-existing lung diseases and their association with income level among patients with lung cancer: a nationwide population-based case-control study in South Korea.BMJ open respiratory research · 2023Article
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- Marked Leukocytosis and Subclavian Vein Occlusion from Pancoast Tumor Mimicking Cellulitis: A Case Report.Case reports in oncologyArticle
Corrections and comments
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Authors and funding
17 authors at 7 institutions in 2 countries.
Funding
Abstract
objectiveLung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data.
designCase-control study.
settingAmbulatory care clinics at a large tertiary care academic health centre in the USA. PARTICIPANTS, OUTCOMES: We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates.
resultsEleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1).
conclusionsPatients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
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