The association between symptoms and bladder or renal tract cancer in primary care: a systematic review
British Journal of General Practice
Royal College of General Practitioners
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BACKGROUND: Appropriate selection for further investigation of patients presenting in primary care with symptoms that may indicate cancer is key to early diagnosis. AIM: To quantify the risk of urinary tract cancer in patients presenting in primary care with symptoms that may indicate bladder or renal cancer. DESIGN AND SETTING: Systematic review of studies relating to bladder or renal cancer in primary care. METHOD: Databases searched were MEDLINE, PreMEDLINE, Embase, the Cochrane Library, Web of Science (SCI and SSCI), and ISI Proceedings from 1980 to August 2014, and PsycINFO (1980-2012) and BioMed Central (inception to 2012) for retrospective, prospective, or case-control diagnostic accuracy studies of symptomatic patients presenting to primary care with one or more symptoms for whom follow-up data were available. The target conditions were bladder or renal cancer. The studies were appraised using the QUADAS-2 tool. RESULTS: Eleven studies with 3 451 675 patients were included. The positive predictive value (PPV) from meta-analysis of visible haematuria was 5.1% in adult patients. It increased with age and was higher in males. The PPVs of other single symptoms were very low, with the highest non-haematuria PPV being 1.4% for anaemia in males. Fewer data were available on the PPVs of symptom combinations. Generally, these data showed that, with the exception of symptom combinations including haematuria, these were very low. CONCLUSION: The only high-risk feature of bladder/renal cancer in primary care was visible haematuria, and this clearly warrants investigation. However, not all patients with one of these cancers experience haematuria, so a policy restricting investigation to patients with haematuria will inevitably delay the diagnosis in some patients.
This article presents a systematic review undertaken as part of the 2015 NICE guideline on Suspected cancer: recognition and referral, which was developed by the National Collaborating Centre for Cancer (NCC-C). The NCC-C receives funding from the National Institute for Health and Care Excellence (NICE). William Hamilton is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. This article was not subject to any further funding. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NICE, the NIHR, or the Department of Health in England.
This is the final version of the article. Available from Royal College of General Practitioners via the DOI in this record.
Vol. 65 (640), pp. e769 - e775
Place of publication