Features of childhood cancer in primary care: a population-based nested case-control study

Br J Cancer. 2012 Feb 28;106(5):982-7. doi: 10.1038/bjc.2011.600. Epub 2012 Jan 12.


Background: This study investigated the risk of cancer in children with alert symptoms identified in current UK guidance, or with increased consultation frequency in primary care.

Methods: A population-based, nested case-control study used data from the General Practice Research Database. In all, 1267 children age 0-14 years diagnosed with childhood cancer were matched to 15,318 controls. Likelihood ratios and positive predictive values (PPVs) were calculated to assess risk.

Results: Alert symptoms recorded in the 12 and 3 months before diagnosis were present in 33.7% and 27.0% of cases vs 5.4% and 1.4% of controls, respectively. The PPV of having cancer for any alert symptom in the 3 months before diagnosis was 0.55 per 1000 children. Cases consulted more frequently particularly in the 3 months before diagnosis (86% cases vs 41% controls). Of these, 36% of cases and 9% of controls had consulted 4 times or more. The PPV for cancer in a child consulting 4 times or more in 3 months was 0.13 per 1000 children.

Conclusion: Alert symptoms and frequent consultations are associated with childhood cancer. However, individual symptoms and consultation patterns have very low PPVs for cancer in primary care (e.g., of 10,000 children with a recorded alert symptom, approximately 6 would be diagnosed with cancer within 3 months).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Family Practice
  • Female
  • Humans
  • Infant
  • Male
  • Neoplasms / diagnosis*
  • Neoplasms / epidemiology*
  • Population Surveillance
  • Primary Health Care
  • Risk
  • United Kingdom / epidemiology