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Br J Gen Pract. 2014 Dec;64(629):e788-93. doi: 10.3399/bjgp14X682873.

Risk of breast cancer in symptomatic women in primary care: a case-control study using electronic records.

Author information

1
University of Exeter Medical School, Exeter.

Abstract

BACKGROUND:

Breast cancer is the most common cancer in the UK. GPs are encouraged to refer all women whose symptoms may represent cancer, rather than selecting those at highest risk.

AIM:

To identify and quantify features of breast cancer in primary care.

DESIGN AND SETTING:

A UK case-control study using the Clinical Practice Research Database (CPRD).

METHOD:

Possible features of breast cancer were identified in the year before diagnosis, and odds ratios calculated using conditional logistic regression. Positive predictive values (PPVs) were estimated for consulting women.

RESULTS:

A total of 3994 women aged ≥40 years with breast cancer between 2000 and 2009, and 16 873 age-, sex-, and practice-matched controls were studied. Median age at diagnosis was 63 years (interquartile range 55-74 years). Four features were significantly associated with breast cancer: breast lump (odds ratio [OR] 110; 95% confidence interval [CI] = I88 to 150), breast pain (OR = 4.2; 95% CI = 3.0 to 6.0), nipple retraction (OR = 26; 95% CI = 10 to 64), nipple discharge (OR = 19; 95% CI = 8.6 to 41): all P-values <0.01. In the year before diagnosis, 1762 (44%) of cases had a breast lump compared with 132 (0.8%) controls. The PPV of breast cancer with a breast lump was 4.8% in women aged 40-49 years, rising to 48% in women aged >70 years. PPVs were lower in women who also reported breast pain.

CONCLUSION:

Generally, the figures support current referral practice. However, the low likelihood of cancer for all the non-lump symptoms means that the current guidance recommends investigation for possible cancer at a more liberal risk threshold than for other cancers. Although supported by patients, this may not meet current NHS criteria for cost-benefit.

KEYWORDS:

breast cancer; diagnosis; primary health care

PMID:
25452544
PMCID:
PMC4240152
DOI:
10.3399/bjgp14X682873
[Indexed for MEDLINE]
Free PMC Article

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