Things that you should get checked out…

It’s not often that a news story has me printing off several scientific articles and reaching for my calculator, but a new study published today caught my interest. It is called “Alarm Symptoms and identification of non-cancer diagnoses in primary care: cohort study” and was published in the British Medical Journal (BMJ).  It was written by Roger Jones and colleagues.

Primary care means your local GP. This study looked at was how many people with certain symptoms developed cancer or developed a disease that wasn’t cancer. They also looked at how many people didn’t receive a diagnosis, e.g. how many people had a symptom but their GP didn’t know what caused it.  In this study they looked at the diagnosis at 3 months and 3 years.

As the authors of the paper point out, an “average GP” with about 2,000 people under their care probably sees seven new cases of cancer, four strokes and six heart attacks in a year. That means most of the people they see do not have a life threatening condition.

This study looked at four “alarm symptoms”, things that COULD indicate you have cancer. They were:

1 Blood in your urine (pee) – haematuria

2 Coughing up blood – haematuria

3 Problems swallowing – dysphagia

4 Bleeding from your bottom – rectal bleeding

If you have any of theses symptoms, you should visit a GP and get them checked out.  The risk of cancer increases with age, so if you are over 65 and you have any of these symptoms you should definitely mention it to your GP (even if it is embarrassing).

The BBC have reported this research as “Study urges quicker patient tests“, if you want an overview of the research this is a good article to read. You can also read about this research on Medical News Today called “Alarm Symptoms – Timely Investigation and Diagnosis“.  As always, it’s interesting to compare how different places report the same study.

What do I think of the results? I think it is a good study, it is published in the BMJ which is a reputable journal and was carried out using data from a very large number of patients (762,325). It was carried out using GP’s records from the UK so the results are relevant to those receiving NHS care (sometimes studies done in America aren’t directly relevant to how diseases or symptoms are treated in the UK).

I’ll give a summary of the results below, before you look at them bear in mind that:

1 these are averages, what is true for the general population may not be true for you as an individual.

2 you can’t diagnose cancer based on one symptom, your GP needs to ask  you for more details and examine you before deciding if you are at risk for developing cancer.

3 the numbers are averages, the actual values are slightly different for men and for women, on the whole men have a slightly higher risk.

4 the older you are the more likely you are to develop cancer, so if you are under 45 your risk of developing cancer is much lower than if you are over 75 years. So for example if you are under 45 and have rectal bleeding there is a 0.22% chance it’s caused by cancer but if your are 75 and have rectal bleeding there is a 7.2% chance it’s caused by cancer.

5 The numbers given below are percentages and the results were gathered 3 years after people first went to their GP complaining of the symptom in question.

* At 3 years from first reporting the symptom (diagnoses of cancer were most often made in the first three months after the onset of alarm symptoms).

Data from:

Jones et al BMJ “Alarm symptoms in early diagnosis of cancer in primary care cohort study using general practice research database (May 2007)

Jones et al BMJ “Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study (August 2009)

So what does this all mean? If you have any of the symptoms mentioned above (blood in your urine, difficulty swallowing, rectal bleeding or you are coughing up blood) you should go to your GP and get it checked out. The chances are it’s not cancer, but it is better to be sure.  Don’t be surprised if your doctor isn’t sure of the cause, these things are common and happen to a lot of people and we don’t always know why.

Remember, if your symptoms are regular and consistent (i.e. always there) or are progressive (gradually get worse over time), go back to your doctor again. Doctors aren’t mind readers they won’t know something is still wrong if you don’t tell them!