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Diagnosis of lung cancer in primary care: a structured review

Diagnosis of lung cancer in primary care: a structured review Background. Lung cancer has the highest cancer incidence and mortality in the UK. Despite this, an individual GP encounters only one new presentation approximately every 8 months, so gains relatively little experience of its diagnosis. This is partly addressed by referral guidelines which aim to help GPs in selection of patients for chest X-ray or referral for specialist investigation.Objective. The purpose of this study was to review the primary care presenting features of lung cancer, in the light of the UK Referral Guidelines for Suspected Cancer.Methods. A structured literature review was carried out.Results. Little research has been undertaken in primary care, and the predictive values for most symptoms are unknown. Approximate likelihood ratios could be calculated for six symptoms or signs: haemoptysis 13; fatigue 5.7; cough 5.3; finger clubbing 3.9; weight loss 2.9; and dyspnoea 1.5–5.7, but none of these figures derived from single primary care studies. Three recommendations for urgent investigation of possible lung cancer in the UK Referral Guidelines are questioned: for unexplained dyspnoea, hoarseness or cervical lymphadenopathy. For all these presentations, other serious diagnoses are more likely.Conclusion. The UK Guidelines for referral of suspected lung cancer have a weak evidence base. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Family Practice Oxford University Press

Diagnosis of lung cancer in primary care: a structured review

Hamilton, William; Sharp, Deborah
Family Practice , Volume 21 (6) – Dec 1, 2004
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References (88)

Publisher
Oxford University Press
Copyright
Family Practice Vol. 21, No. 6 © Oxford University Press 2004, all rights reserved.
ISSN
0263-2136
eISSN
1460-2229
DOI
10.1093/fampra/cmh605
pmid
15520035
Publisher site
See Article on Publisher Site

Abstract

Background. Lung cancer has the highest cancer incidence and mortality in the UK. Despite this, an individual GP encounters only one new presentation approximately every 8 months, so gains relatively little experience of its diagnosis. This is partly addressed by referral guidelines which aim to help GPs in selection of patients for chest X-ray or referral for specialist investigation.Objective. The purpose of this study was to review the primary care presenting features of lung cancer, in the light of the UK Referral Guidelines for Suspected Cancer.Methods. A structured literature review was carried out.Results. Little research has been undertaken in primary care, and the predictive values for most symptoms are unknown. Approximate likelihood ratios could be calculated for six symptoms or signs: haemoptysis 13; fatigue 5.7; cough 5.3; finger clubbing 3.9; weight loss 2.9; and dyspnoea 1.5–5.7, but none of these figures derived from single primary care studies. Three recommendations for urgent investigation of possible lung cancer in the UK Referral Guidelines are questioned: for unexplained dyspnoea, hoarseness or cervical lymphadenopathy. For all these presentations, other serious diagnoses are more likely.Conclusion. The UK Guidelines for referral of suspected lung cancer have a weak evidence base.

Journal

Family Practice – Oxford University Press

Published: Dec 1, 2004

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