School of Clinical Sciences, University of Bristol, Level 6 UHB Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
Br J Cancer. 2013 Jun 11;108(11):2329-33. doi: 10.1038/bjc.2013.191. Epub 2013 Apr 25.
Teenagers and young adults (TYA, 15-24 years) diagnosed with cancer report repeated visits to primary care before referral. We investigated associations of symptoms and consultation frequency in primary care with TYA cancers.
Population-based, case-control study was carried out using data from the Clinical Practice Research Datalink (CPRD). A total of 1064 TYA diagnosed with cancer were matched to 13,206 controls. Symptoms independently associated with specific cancers were identified. Likelihood ratios (LRs) and positive predictive values (PPVs) were calculated.
In the 3 months before diagnosis, 397 (42.9%) cases consulted > or =4 times vs 593(11.5%) controls (odds ratio (OR): 12.1; 95% CI: 9.7, 15.1), yielding a PPV for any cancer of 0.018%. The LR of lymphoma with a head/neck mass was 434 (95% CI: 60, 3158), with a PPV of 0.5%. Corresponding figures in other cancers included - LR of leukaemia with lymphadenopathy (any site): 29 (95% CI: 8, 112), PPV 0.015%; LR of CNS tumour with seizure: 56 (95% CI: 19, 163), PPV 0.024%; and LR of sarcoma with lump/mass/swelling: 79 (95% CI: 24, 264), PPV 0.042%.
Teenagers and young adults with cancer consulted more frequently than controls in the 3 months before diagnosis. Primary care features of cancer match secondary care reports, but were of very low risk; nonetheless, some features increased the likelihood of cancer substantially and should be taken seriously when assessing TYA.
被诊断患有癌症的青少年和年轻人（15-24 岁）在转诊前经常到初级保健机构就诊。我们调查了初级保健中症状和就诊频率与青少年癌症之间的关联。
使用来自临床实践研究数据库（CPRD）的数据进行了基于人群的病例对照研究。共纳入 1064 名被诊断患有癌症的青少年患者，并与 13206 名对照相匹配。确定与特定癌症独立相关的症状。计算了似然比（LR）和阳性预测值（PPV）。
在诊断前的 3 个月内，397 例（42.9%）病例就诊次数≥4 次，而 593 例（11.5%）对照就诊次数为 1 次（比值比（OR）：12.1；95%CI：9.7，15.1），任何癌症的 PPV 为 0.018%。有头/颈部肿块的淋巴瘤的 LR 为 434（95%CI：60，3158），PPV 为 0.5%。其他癌症的对应数值包括 - 伴有淋巴结病的白血病的 LR（任何部位）：29（95%CI：8，112），PPV 为 0.015%；中枢神经系统肿瘤伴癫痫发作的 LR：56（95%CI：19，163），PPV 为 0.024%；肉瘤伴肿块/肿胀/肿胀的 LR：79（95%CI：24，264），PPV 为 0.042%。
在诊断前的 3 个月内，患有癌症的青少年和年轻人比对照组就诊更频繁。初级保健中癌症的特征与二级保健报告相符，但风险非常低；尽管如此，一些特征还是大大增加了癌症的可能性，在评估青少年时应认真对待。
