CANCERS IN PRIMARY CARE 23/7/12 Julia Hippisley-Cox and her team used information from QResearch database and

published a series of papers in the British Journal of General Practice (2011;61:e707-714, 2011; 61:715-723, 2012;62:24-25, 2012;62:26-27) and BMJ (2012;344:10.1136/bmj.d8009). Ive abstracted from their data approximate hazard ratios 2 for the various cancers studied and entered these in the table below along with + or to indicate the effect of age and sex. From ISD Ive obtained figures for the annual incidence in Scotland in 2010 of the same five cancers (http://www.isdscotland.scot.nhs.uk/Health-Topics/Cancer/Publications/2012-0424/Cancer_in_Scotland_summary_m.pdf). These figures dont enable a general practitioner to estimate absolute risk of cancer. However, they do indicate relative probabilities. For instance, in someone with isolated loss of appetite, lung cancer is as likely as colorectal cancer and more likely than gastro-oesophageal cancer: this suggests a CXR might be a useful early investigation. The only features specific for one of the five cancers are local bleeding and abdominal distension. Other features indicate likely cancer without specifying type. If symptoms, signs and blood test results are non-specific, review in general practice or referral to a general physician or surgeon might be more appropriate than referral directly for endoscopy. lung Annual incidence in 2010 in Scotland Male Age Family history Loss of appetite Weight loss Abdominal pain Smoking Hb<110 Change in Bowel Habit Local bleeding COPD Diabetes Chronic pancreatitis Abdominal distension Dysphagia 5000 colorectal 4000 gastropancreatic oesophageal 1400 700 ovary 600

+ + 4-5 4-6 3-11 2 24 1-2

+ + 2 4-8 7 3 0-2 30

+ + 4-10 4-6 4-5 3 2 7-25

+ + 2-4 3-12 4-5 2

+ 10 5 2 7 2

0-2 7 2 3-4 0-3 130-140 0-3 23