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The research is highlighted in a special collection of studies that focus on early cancer detection, hailed by the Editors as “cutting edge, and potentially scalable, innovations that have the potential to inform research, policy, and clinical cancer management.”

A photo of various types of blood sample collection tubes

“We’re delighted to have had our paper included in this special collection, alongside five others from leaders in cancer detection across the world.” Said Dr Brian Nicholson, practicing GP and Academic Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford.

The research was by Dr Nicholson, from the Department’s Cancer Research Group, and colleagues, including ARC OxTV theme leads, Dr Raphael Perera-Salazar and Prof Paul Aveyard, outlines how routine clinical tests could be widely used to estimate the risk of cancer for people visiting their GPs with unexpected weight loss (UWL).

The research builds upon similar work originally from the NIHR CLAHRC Oxford, led by Dr Constantinos Koshiaris, who was also a co-author in this work.

UWL is often one of the first noticeable symptoms of a broad range of cancers. However, there are many other non-cancer reasons for UWL, and only about 2 in 100 people with UWL will go on to receive a cancer diagnosis.

As such, it’s important, for both patients and health service purses, to be able to identify those patients for whom cancer is a real possibility and treat them appropriately. Conversely, it’s important that patients for which UWL is unlikely to be linked to cancer are spared over-investigation, potential misdiagnosis, and the wider impacts on their lives of receiving a cancer diagnosis.

Briefly, to do this, the researchers analysed the electronic health records of 63,693 people in the England who visited their GP with UWL between January 2000 and December 2012, combining symptoms and test results to predict their risk of a cancer diagnosis within 6 months.

The research also showed that the risk scores developed were superior in ruling in or out cancer than the more traditional symptoms-only based approach commonly used. However, the researchers note that further research is required to validate these findings in different data sets and populations.

In an accompanying editorial the editor’s note that the research, “clearly demonstrate[s] innovation in the use of routine clinical tools at scale. This type of model could potentially be scaled-up in under-resourced settings.”

“What’s different about our study is that we were able to incorporate information from blood tests into the decision-making process, this allowed us to identify the impact these tests are likely to have in detecting those individuals that go on to develop cancer.” Said co-author and Professor of Medical Statistics Dr Rafael Perera, also from the Nuffield Department of Primary Care Health Sciences, University of Oxford, and NIHR ARC OxTV Novel Methods to Aid and Evaluate Implementation Theme lead.

Publication:

Brian D. Nicholson et al, Combining simple blood tests to identify primary care patients with unexpected weight loss for cancer investigation: Clinical risk score development, internal validation, and net benefit analysis, PLOS Medicine (2021). DOI: 10.1371/journal.pmed.1003728

PLOS Medicine Editorial to Special issue:

https://speakingofmedicine.plos.org/2021/08/31/editor-choice-plos-medicine-special-issue-early-detection-and-minimal-residual-disease/

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