{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:09:26Z","timestamp":1792084166079,"version":"4.4.0"},"reference-count":72,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C18081\/A31373;"],"award-info":[{"award-number":["C18081\/A31373;"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C18081\/A18180"],"award-info":[{"award-number":["C18081\/A18180"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["EDDCPJT\\100018"],"award-info":[{"award-number":["EDDCPJT\\100018"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["RCCPDF\/100005"],"award-info":[{"award-number":["RCCPDF\/100005"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["CTRQQR-2021\\100002"],"award-info":[{"award-number":["CTRQQR-2021\\100002"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["EDDAPA-2022\/100002"],"award-info":[{"award-number":["EDDAPA-2022\/100002"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged \u226530 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations.<\/jats:p>\n<jats:p>A total of 9,427\/425,549 (2.2%) patients with abdominal pain and 1,148\/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged \u226560, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient\u2019s cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged \u226560 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004426","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T17:21:48Z","timestamp":1722360108000},"page":"e1004426","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Predictive value of abnormal blood tests for detecting cancer in primary care patients with nonspecific abdominal symptoms: A population-based cohort study of 477,870 patients in England"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1837-1542","authenticated-orcid":true,"given":"Meena","family":"Rafiq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3845-9493","authenticated-orcid":true,"given":"Cristina","family":"Renzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0643-7890","authenticated-orcid":true,"given":"Becky","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4155-7756","authenticated-orcid":true,"given":"Nadine","family":"Zakkak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2873-7421","authenticated-orcid":true,"given":"Georgios","family":"Lyratzopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-1922","authenticated-orcid":true,"given":"Matthew","family":"Barclay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"issue":"670","key":"pmed.1004426.ref001","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.3399\/bjgp18X695777","article-title":"Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care","volume":"68","author":"K Holtedahl","year":"2018","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pmed.1004426.ref002","doi-asserted-by":"crossref","first-page":"e0228033","DOI":"10.1371\/journal.pone.0228033","article-title":"Patterns of symptoms possibly indicative of cancer and associated help-seeking behaviour in a large sample of United Kingdom residents\u2014The USEFUL study","volume":"15","author":"PC Hannaford","year":"2020","journal-title":"PLoS ONE"},{"issue":"2","key":"pmed.1004426.ref003","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3109\/00365529409090447","article-title":"The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population: a report from the Abdominal Symptom Study","volume":"29","author":"L Agreus","year":"1994","journal-title":"Scand J Gastroenterol"},{"key":"pmed.1004426.ref004","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/BF01719573","article-title":"Epidemiology of abdominal symptoms in a random population: prevalence, incidence, and natural history","volume":"10","author":"L Kay","year":"1994","journal-title":"Eur J Epidemiol"},{"issue":"2","key":"pmed.1004426.ref005","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.neo.2017.11.005","article-title":"Symptom signatures and diagnostic timeliness in cancer patients: a review of current evidence","volume":"20","author":"MM Koo","year":"2018","journal-title":"Neoplasia"},{"issue":"8","key":"pmed.1004426.ref006","doi-asserted-by":"crossref","first-page":"e1003708","DOI":"10.1371\/journal.pmed.1003708","article-title":"Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study","volume":"18","author":"A Herbert","year":"2021","journal-title":"PLoS Med"},{"issue":"718","key":"pmed.1004426.ref007","doi-asserted-by":"crossref","first-page":"e361","DOI":"10.3399\/BJGP.2021.0552","article-title":"Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study","volume":"72","author":"SJ Price","year":"2022","journal-title":"Br J Gen Pract"},{"key":"pmed.1004426.ref008","unstructured":"NHS England. 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