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

Faye Dannhauser, Natalia Calanzani, Aiman Aslam, Aina Chang, Alka Vimarkant, Malik Majeed, Fiona M Walter, Yin Zhou

Abstract readReview

In one paragraph

Review in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Faye DannhauserQueen Mary University of London, Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Charterhouse Square, London, EC1M 6BT, UK.

Natalia CalanzaniUniversity of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, Academic Primary Care, Aberdeen, AB25 2ZD, UK.

Aiman AslamQueen Mary University of London, Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Charterhouse Square, London, EC1M 6BT, UK.

Aina ChangImperial College London, Department of Immunology and Inflammation, Commonwealth Building, The Hammersmith Hospital, London, W12 0NN, UK.

Alka VimarkantKings College London, Strand, London, WC2R 2LS, UK.

Malik MajeedBarts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London, E1 1BB, UK.

Fiona M WalterQueen Mary University of London, Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Charterhouse Square, London, EC1M 6BT, UK.

Yin ZhouQueen Mary University of London, Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Charterhouse Square, London, EC1M 6BT, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Most cancers are diagnosed following symptomatic presentation. European guidelines supporting general practitioner cancer referrals largely focus on 'alarm' symptoms. However, about half of cancer patients do not present with alarm symptoms. Understanding cancer risk in these patients can help identify those who might need further investigations. This systematic review quantified positive predictive values (PPVs) of recurrent and persistent symptoms for cancer. Evidence from 21 studies reporting on nearly 200,000 patients, identified PPVs for 33 recurrent and 22 persistent symptoms. 'Persistent' and 'recurrent' symptoms were inconsistently defined. In addition to recurrent 'alarm' symptoms, recurrent abdominal distension, abdominal pain and rectal bleeding had PPVs above 3%, the existing English referral threshold, in patients younger than currently recommended for specialist investigation. Persistent symptoms were predominately studied in referred populations. Clearer definitions of recurrence and persistence, and prospective validation of cancer risk for patients with non-alarm symptoms across all age groups are needed to refine guidance and support early cancer diagnosis.

Indexed as

Cancer riskCancer symptomsPersistent symptomRecurrent symptomSymptom presentation

Identifiers

PMID41852353

DOI10.1016/j.lanepe.2026.101638

PMCPMC12992075

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LicenceCC BY-NC

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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.