4.4 Article

Inflammatory marker testing in primary care in the year before Hodgkin Lymphoma diagnosis: a UK population-based case-control study in patients aged <= 50 years

Journal

BRITISH JOURNAL OF GENERAL PRACTICE
Volume 72, Issue 721, Pages E546-E555

Publisher

ROYAL COLL GENERAL PRACTITIONERS
DOI: 10.3399/BJGP.2021.0617

Keywords

blood tests; diagnostic time window; general practice; Hodgkin lymphoma; inflammatory markers

Funding

  1. RM Partners Pan-London Cancer Research Fellowship
  2. Cancer Research UK Advanced Clinician Scientist Fellowship [C18081/A18180]
  3. Cancer Research UK Population Research Catalyst Award [C8640/A23385]
  4. International Alliance for Cancer Early Detection [C18081/A31373]

Ask authors/readers for more resources

A case-control study in UK primary care found that the use of inflammatory marker tests and the presence of abnormal results increase significantly in Hodgkin lymphoma patients several months before diagnosis. This suggests the existence of a diagnostic time window with a considerable length in many Hodgkin lymphoma patients, many of whom do not have other red-flag features.
Background Proinflammatory conditions are associated with increased risk of Hodgkin lymphoma, although the neoplastic process per se often induces an inflammatory response. Aim To examine pre-diagnostic inflammatory marker test use to identify changes that may define a 'diagnostic window' for potential earlier diagnosis. Design and setting This was a matched case-control study in UK primary care using Clinical Practice Research Datalink data (2002-2016). Method Primary care inflammatory marker test use and related findings were analysed in 839 Hodgkin lymphoma patients and 5035 controls in the year pre-diagnosis. Poisson regression models were used to calculate monthly testing rates to examine changes over time in test use. Longitudinal trends in test results and the presence/absence of 'red-flag' symptoms were examined. Results In patients with Hodgkin lymphoma, 70.8% (594/839) had an inflammatory marker test in the year pre-diagnosis versus 16.2% (816/5035) of controls (odds ratio 13.7, 95% CI = 11.4 to 16.5, P<0.001). The rate of inflammatory marker testing and mean levels of certain inflammatory marker results increased progressively during the year pre-diagnosis in Hodgkin lymphoma patients while remaining stable in controls. Among patients with Hodgkin lymphoma with a pre-diagnostic test, two-thirds (69.5%, 413/594) had an abnormal result and, among these, 42.6% (176/413) had no other 'red-flag' presenting symptom/sign. Conclusion Increases in inflammatory marker requests and abnormal results occur in many patients with Hodgkin lymphoma several months pre-diagnosis, suggesting this period should be excluded in aetiological studies examining inflammation in Hodgkin lymphoma development, and that a diagnostic time window of appreciable length exists in many patients with Hodgkin lymphoma, many of whom have no other red-flag features.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.4
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available