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New research recommends that physicians consider laryngeal cancer in patients with persistent sore throat, especially if it is badociated with dysphagia, dyspnea or earache.
We think of the study, Recognizing laryngeal cancer in primary care: an extensive case-control study using electronic records , published in the British Journal of General Practice (BJGP) can help general practitioners select the most appropriate patients for suspected laryngeal cancer, and could allow earlier screening.
Every year in England, more than 1,700 people, mostly men, are diagnosed with laryngeal cancer.
In the absence, so far, of studies on primary care, the current recommendation of NICE (National Institute of Health and Excellence in Care) is based on a consensus and suggests an urgent referral for suspected laryngeal cancer in patients with persistent unexplained hoarseness or an unexplained neck nodule.
L & # 39; study
The new study used patient records from more than 600 general practitioners as part of the UK Clinical Practice Research Database.
Led by the Faculty of Medicine at Exeter University, he examined 806 patients ≥ 40 diagnosed with laryngeal cancer and 3559 controls.
A total of 34 symptoms and 14 examinations were considered at the beginning of the study; of these, 10 remained significant in the final model.
Results
The study found that hoarseness was the highest individual risk symptom of laryngeal cancer, at 2.7% (close to the 3% NICE threshold of investigation).
The risk increased to> 3% when hoarseness was completed by dysphagia, oral symptoms, insomnia, earache or recurrent dyspnea.
Patients reporting combinations of unidentified symptoms in NICE recommendations – such as sore throat with dysphagia, recurrent dyspnea or earache – had risk estimates> 5%.
The highest risk was hoarseness with sore throat (12%) or raised inflammatory markers (15%).
Unexpectedly, the authors of the study found no badociation between neck mbades and laryngeal cancer. However, they say that unexplained cervical mbades are high-risk symptoms of lymphoma and, therefore, deserve to be referred.
Professor Willie Hamilton, one of the authors of the study, said in a press release: "This research is important – when the NICE guidelines for cancer research were published, nothing did not prove that the practices of GPs guided this – nor to inform general practitioners.A hoarseness serious enough to be reported to general practitioners justifies an investigation.In addition, our research has shown the potential severity of certain combinations of symptoms previously considered to low risk. "
Strengths and limitations
The study used primary care data and included more than 800 laryngeal cancer patients in the UK. Another highlight is the search for possible symptoms in online patient forums and in existing literature. The authors therefore believe that it is unlikely that relevant symptoms have been omitted.
One possible limitation is that researchers depended on the quality of the general practitioner's registration and that some data would have been omitted or written in the free text section, to which researchers had no access.
This study was funded by the National Institute of Health Research (NIHR), by the NHRI's Policy Research Unit on Cancer Awareness, Screening and Early Diagnosis and grants from the NHRI program for applied research.
Professor William Hamilton was the Clinical Lead for the 2015 Revision of the National Institute Guidelines for Excellence in Health and Care (NICE) on the Investigation of Cancer presumed. His contribution to the article is in his personal capacity and does not represent the point of view of the guideline development group nor of NICE itself.
Br J Gen Pract January 28, 2019; bjgp19X700997. DOI: https://doi.org/10.3399/bjgp19X700997
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