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Br J Gen Pract. 2015 May;65(634):e289-94. doi: 10.3399/bjgp15X684805.

Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records.

Author information

1
University of Exeter Medical School, Exeter.
2
North Wales Centre for Primary Care Research, Bangor University, Wrexham.
3
Department of Primary Care Health Sciences, University of Oxford, Oxford.
4
Department of Public Health and Primary Care, University of Cambridge, Cambridge.

Abstract

BACKGROUND:

In the UK, approximately five people are diagnosed with Hodgkin lymphoma (HL) daily. One-tenth of diagnoses are in those aged >75 years.

AIM:

To establish a symptom profile of HL and quantify their risk in primary care patients aged ≥40 years.

DESIGN AND SETTING:

Matched case-control study using Clinical Practice Research Datalink patient records.

METHOD:

Putative clinical features of HL were identified in the year before diagnosis. Results were analysed using conditional logistic regression and positive predictive values (PPVs) calculated for the consulting population.

RESULTS:

Two-hundred and eighty-three patients aged ≥40 years, diagnosed with HL between 2000 and 2009, and 1237 age, sex, and general practice-matched participants were studied. Six features were independently associated with HL: lymphadenopathy (OR 280, 95% confidence interval [CI] = 25 to 3100), head and neck mass not described as lymphadenopathy (OR 260, 95% CI = 21 to 3200), other mass (OR 12, 95% CI = 4.4 to 35), thrombocytosis (OR 6.0, 95% CI = 2.6 to 14), raised inflammatory markers (OR 5.2, 95% CI = 3.0 to 9.0), and low full blood count (OR 2.8, 95% CI = 1.6 to 4.8). Lymphadenopathy per se has a positive predictive value (PPV) of 5.6% for HL in patients aged ≥60 years.

CONCLUSION:

Consistent with secondary care findings, lymphadenopathy is the clinical feature with the highest risk of HL in primary care and warrants urgent investigation.

KEYWORDS:

Hodgkin lymphoma; diagnosis; primary health care

PMID:
25918333
PMCID:
PMC4408504
DOI:
10.3399/bjgp15X684805
[Indexed for MEDLINE]
Free PMC Article

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