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Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records

British Journal of Cancer, ISSN: 1532-1827, Vol: 120, Issue: 11, Page: 1045-1051
2019
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GPs should not use inflammatory marker tests to rule out serious conditions

Blood tests that detect inflammation, known as inflammatory marker tests, are not sensitive enough to rule out serious underlying conditions and GPs should not use

Article Description

Background: Early identification of cancer in primary care is important and challenging. This study examined the diagnostic utility of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and plasma viscosity) for cancer diagnosis in primary care. Methods: Cohort study of 160,000 patients with inflammatory marker testing in 2014, plus 40,000 untested matched controls, using Clinical Practice Research Datalink (CPRD), with Cancer Registry linkage. Primary outcome was one-year cancer incidence. Results: Primary care patients with a raised inflammatory marker have a one-year cancer incidence of 3.53% (95% CI 3.37–3.70), compared to 1.50% (1.43–1.58) in those with normal inflammatory markers, and 0.97% (0.87–1.07) in untested controls. Cancer risk is greater with higher inflammatory marker levels, with older age and in men; risk rises further when a repeat test is abnormal but falls if it normalises. Men over 50 and women over 60 with raised inflammatory markers have a cancer risk which exceeds the 3% NICE threshold for urgent investigation. Sensitivities for cancer were 46.1% for CRP, 43.6% ESR and 49.7% for PV. Conclusion: Cancer should be considered in patients with raised inflammatory markers. However, inflammatory markers have a poor sensitivity for cancer and are therefore not useful as ‘rule-out’ test.

Bibliographic Details

Watson, Jessica; Salisbury, Chris; Banks, Jonathan; Whiting, Penny; Hamilton, Willie

Springer Science and Business Media LLC

Medicine; Biochemistry, Genetics and Molecular Biology

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