Particular attention should be paid to men and patients who are over the age of 65 in the year after the first presentation of an alarm symptom.

The evidence base for using alarm symptoms to identify cancer has been weak, and GPs often use individual approaches to the collection and analysis of data in the course of consultations.

But researchers from Kings College London have identified the likelihood of being diagnosed with a related cancer after the first episode of four common alarm symptoms — haematuria, haemoptysis, dysphagia and rectal bleeding — often encountered in primary care.

For the study, first occurrences of the alarm symptoms were identified in 762,325 patients aged 15 and older.

They found that 59 per cent of men and 51 per cent of women developed urinary tract cancer within three years of being found to have haematuria.

Fifty eight per cent of men and 54 per cent of women developed oesophageal cancer after a diagnosis of dysphagia.

However, alarm symptoms for haemoptysis had a lower sensitivity for a diagnosis of respiratory tract cancer, with only 22 per cent of men and 13 per cent of women developing the cancer.

Rectal bleeding led to a diagnosis of rectal cancer in 33 per cent in men and 25 per cent in women.

The researchers found that the increased likelihood of a diagnosis of cancer remained high during the first year after an alarm symptom but gradually declined over time and was not significantly high after five years.

Lead researcher Roger Jones, professor of general practice at Kings College London, said that the study provided additional evidence for GPs to base their cancer referral decisions on.

‘GPs interpret the alarm symptoms differently before addressing the two week rule for urgent referral of patients suspected of having cancer,’ he said.

This study highlights the importance of looking at patients with alarm symptoms, particularly men over the age of 65, said Professor Jones.

But Hull GP Dr Nick Summerton, who has an interest in cancer, said that using alarm symptoms was a very complicated area that could worry people unintentionally and that it could cause a lot of unnecessary referrals.

‘It is important to look for clusters of symptoms and combinations of symptoms, rather than simply the first presentation of a symptom,’ he said. 

Value of cancer alarm symptoms

Haematuria

• 59% of men and 51% of women develop urinary tract cancer.

Rectal bleeding

• 33% of men and 25% of women go on to develop rectal cancer.

Dysphagia

• 58% of men and 54% of women go on to develop oesophageal cancer.

Haemoptysis

• Lower sensitivity.
• Only 22% of men and 13% of women develop respiratory tract cancer

In general

• Alarm symptoms are more likely to point to cancers in over-65s.
• Cancer likeliest in first year after alarm symptom

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