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Presenting Symptoms and Cancer Stage at Diagnosis


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In a population-based study reported in The Lancet Oncology, Koo et al found that presenting symptoms of cancer were mostly associated with stage earlier than stage IV, suggesting a benefit of symptom awareness campaigns based on common symptoms.

As stated by the investigators, “Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease.”

“Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced-stage disease.”
— Koo et al

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Study Details

The cross-sectional study included data from 7,997 patients aged ≥ 25 years old with 1 of 12 types of solid tumors (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancers) from the English National Cancer Diagnosis Audit 2014. The associations between diagnosis at stage I to III vs IV and presentation with 1 or more of 19 common presenting symptoms plus an “any other symptom” category were evaluated.

Key Findings

The proportion of patients diagnosed with stage IV disease varied from 1% (8 of 584 patients) for abnormal mole to 80% (84 of 105 patients) for neck lump. Symptoms associated with intermediate rates for stage IV disease included rectal bleeding, at 16% (80 of 498); change in bowel habits, at 29% (236 of 819); abdominal pain, at 37% (156 of 424); fatigue, at 47% (170 of 365); dyspnea, at 56% (289 of 513); and chest pain, at 62% (181 of 293).  

Neck lump, chest pain, and back pain were consistently associated with increased likelihood of diagnosis at stage IV; abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding were consistently associated with earlier-stage diagnosis.

For 13 of 20 symptoms (abnormal mole, breast lump, postmenopausal bleeding, rectal bleeding, lower urinary tract symptoms, hematuria, change in bowel habits, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the “any other symptom” category), more than 50% of patients were diagnosed at stages earlier than stage IV.

For 19 (all those noted above plus cough, hemoptysis, chest infection, dyspnea, chest pain, back pain, and neck lump) of the symptoms (all except for neck lump), more than one-third of patients were diagnosed at stages earlier than stage IV.

The investigators concluded, “Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced-stage disease.”

Minjoung Monica Koo, PhD, of the Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, University College London, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was funded by the UK Department of Health’s Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis and Cancer Research UK. For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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