Common cancer symptoms at presentation and associated stage at diagnosis
Early diagnosis interventions such as cancer symptom awareness campaigns and fast-track diagnostic pathways for cancer focus on specific presenting symptoms of cancer but such efforts may have limited clinical utility if the selected symptoms represent advanced stage. Current evidence examining how symptoms at presentation are associated with stage is limited, and typically relate to individual cancer sites. We sought to examine associations between common presenting symptoms and their associations with stage at diagnosis using a population-based incident cohort of cancer patients.
We analysed English National Cancer Diagnosis Audit (2014) data on 7,997 patients with one of twelve solid tumours with a high degree (>80%) of stage completeness: bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oesophageal, oral/oropharyngeal, ovarian, prostate, rectal, and renal cancer. We considered 20 common symptoms in the study population and examined their associations with stage at diagnosis (TNM IV versus I–III, stage completeness >80%) using logistic regression, taking into account whether that symptom was seen alone, or with other symptoms.
There was large variation in the proportion of patients diagnosed with stage IV ranging from 1% (abnormal mole) to 80% (neck lump), with further variation by symptom depending on whether other symptoms were present. Stage IV disease was diagnosed in <20% of patients who presented with abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, or lower urinary tract symptoms; 20–60% of patients with haematuria, change in bowel habit, lower abdominal pain, abdominal pain, hoarseness, fatigue, weight loss, cough, haemoptysis, chest infection, and dyspnoea; and >60% of patients with back pain, chest pain, or neck lump.Adjustment for single/multiple presenting symptom status, and for patient characteristics and cancer diagnosis, indicated broadly comparable patterns of variation for most symptoms.
Presenting symptoms of cancer are variably associated with advanced stage at diagnosis. However, for nearly all examined symptoms large proportions of patients are diagnosed in non-advanced stage. These findings refute concerns that early diagnosis interventions centred on common symptoms of cancer principally expedite the detection of advanced stage disease.