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Br J Gen Pract. 2016 Mar;66(644):e182-8. doi: 10.3399/bjgp16X683989.

Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies 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:

Leukaemia is the eleventh commonest UK cancer. The four main subtypes have different clinical profiles, particularly between chronic and acute types.

AIM:

To identify the symptom profiles of chronic and acute leukaemia in adults in primary care.

DESIGN AND SETTING:

Matched case-control studies using Clinical Practice Research Datalink records.

METHOD:

Putative symptoms of leukaemia were identified in the year before diagnosis. Conditional logistic regression was used for analysis, and positive predictive values (PPVs) were calculated to estimate risk.

RESULTS:

Of cases diagnosed between 2000 and 2009, 4655 were aged ≥40 years (2877 chronic leukaemia (CL), 937 acute leukaemia (AL), 841 unreported subtype). Ten symptoms were independently associated with CL, the three strongest being: lymphadenopathy (odds ratio [OR] 22, 95% confidence interval [CI] = 13 to 36), weight loss (OR 3.0, 95% CI = 2.1 to 4.2), and bruising (OR 2.3, 95% CI = 1.6 to 3.2). Thirteen symptoms were independently associated with AL, the three strongest being: nosebleeds and/or bleeding gums (OR 5.7, 95% CI = 3.1 to 10), fever (OR 5.3, 95% CI = 2.7 to 10), and fatigue (OR 4.4, 95% CI = 3.3 to 6.0). No individual symptom or combination of symptoms had a PPV >1%.

CONCLUSION:

The symptom profiles of CL and AL have both overlapping and distinct features. This presents a dichotomy for GPs: diagnosis, by performing a full blood count, is easy; however, the symptoms of leukaemia are non-specific and of relatively low risk. This explains why many leukaemia diagnoses are unexpected findings.

KEYWORDS:

acute lymphoblastic leukaemia; acute myeloid leukaemia; chronic leukaemia; diagnosis; primary health care

PMID:
26917658
PMCID:
PMC4758497
[Available on 2017-03-01]
DOI:
10.3399/bjgp16X683989
[Indexed for MEDLINE]
Free PMC Article

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