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dc.contributor.authorShephard, E
dc.contributor.authorNeal, R
dc.contributor.authorRose, P
dc.contributor.authorWalter, F
dc.contributor.authorHamilton, W
dc.date.accessioned2016-07-06T11:30:58Z
dc.date.issued2013-04-01
dc.description.abstractBACKGROUND: Kidney cancer accounts for over 4000 UK deaths annually, and is one of the cancer sites with a poor mortality record compared with Europe. AIM: To identify and quantify all clinical features of kidney cancer in primary care. DESIGN: Case-control study, using General Practice Research Database records. METHOD: A total of 3149 patients aged ≥40 years, diagnosed with kidney cancer between 2000 and 2009, and 14 091 age, sex and practice-matched controls, were selected. Clinical features associated with kidney cancer were identified, and analysed using conditional logistic regression. Positive predictive values for features of kidney cancer were estimated. RESULTS: Cases consulted more frequently than controls in the year before diagnosis: median 16 consultations (interquartile range 10-25) versus 8 (4-15): P<0.001. Fifteen features were independently associated with kidney cancer: visible haematuria, odds ratio 37 (95% confidence interval [CI] = 28 to 49), abdominal pain 2.8 (95% CI = 2.4 to 3.4), microcytosis 2.6 (95% CI = 1.9 to 3.4), raised inflammatory markers 2.4 (95% CI = 2.1 to 2.8), thrombocytosis 2.2 (95% CI = 1.7 to 2.7), low haemoglobin 1.9 (95% CI = 1.6 to 2.2), urinary tract infection 1.8 (95% CI = 1.5 to 2.1), nausea 1.8 (95% CI = 1.4 to 2.3), raised creatinine 1.7 (95% CI = 1.5 to 2.0), leukocytosis 1.5 (95% CI = 1.2 to 1.9), fatigue 1.5 (95% CI = 1.2 to 1.9), constipation 1.4 (95% CI = 1.1 to 1.7), back pain 1.4 (95% CI = 1.2 to 1.7), abnormal liver function 1.3 (95% CI = 1.2 to 1.5), and raised blood sugar 1.2 (95% CI = 1.1 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was 1.0% (95% CI = 0.8 to 1.3). CONCLUSION: Visible haematuria is the commonest and most powerful single predictor of kidney cancer, and the risk rises when additional symptoms are present. When considered alongside the risk of bladder cancer, the overall risk of urinary tract cancer from haematuria warrants referral.en_GB
dc.description.sponsorshipThis study was funded by the NIHR Programme Grants for Applied Research funding scheme, RP-PG-0608-10045. William Hamilton was part-funded by a NIHR post-doctoral fellowship.en_GB
dc.identifier.citationVol. 63, No. 609, pp. e250 - e255en_GB
dc.identifier.doi10.3399/bjgp13X665215
dc.identifier.urihttp://hdl.handle.net/10871/22413
dc.language.isoenen_GB
dc.publisherRoyal College of General Practitionersen_GB
dc.relation.urlhttp://bjgp.org/content/63/609/e250en_GB
dc.rights.embargoreasonUnder indefinite embargo due to publisher policy. The final version is available from Royal College of General Practitioners via the DOI in this record.en_GB
dc.subjectAbdominal Painen_GB
dc.subjectAgeden_GB
dc.subjectBack Painen_GB
dc.subjectCase-Control Studiesen_GB
dc.subjectFemaleen_GB
dc.subjectGeneral Practiceen_GB
dc.subjectGreat Britainen_GB
dc.subjectHematuriaen_GB
dc.subjectHumansen_GB
dc.subjectInflammationen_GB
dc.subjectKidney Neoplasmsen_GB
dc.subjectMaleen_GB
dc.subjectMedical Recordsen_GB
dc.subjectMiddle Ageden_GB
dc.subjectNauseaen_GB
dc.subjectOdds Ratioen_GB
dc.subjectPredictive Value of Testsen_GB
dc.subjectPrimary Health Careen_GB
dc.subjectReferral and Consultationen_GB
dc.subjectUrinary Tract Infectionsen_GB
dc.titleClinical features of kidney cancer in primary care: a case-control study using primary care records.en_GB
dc.typeArticleen_GB
dc.identifier.issn0960-1643
exeter.place-of-publicationEnglanden_GB
dc.identifier.eissn1478-5242
dc.identifier.journalBritish Journal of General Practiceen_GB


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