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Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case–control study using electronic records

Shephard, E.A. and Neal, R.D. and Rose, P.W. and Walter, F.M. and Hamilton, W.T. (2015) Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case–control study using electronic records. British Journal of General Practice. e289-e294. DOI: 10.3399/bjgp15X684805

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Abstract

Background In the UK, approximately five people are diagnosed with Hodgkin lymphoma (HL) daily. One-tenth of diagnoses are in those aged >75 years. Aim To establish a symptom profile of HL and quantify their risk in primary care patients aged �40 years. Design and setting Matched case�control study using Clinical Practice Research Datalink patient records. Method Putative clinical features of HL were identified in the year before diagnosis. Results were analysed using conditional logistic regression and positive predictive values (PPVs) calculated for the consulting population. Results Two-hundred and eighty-three patients aged �40 years, diagnosed with HL between 2000 and 2009, and 1237 age, sex, and general practice-matched participants were studied. Six features were independently associated with HL: lymphadenopathy (OR 280, 95% confidence interval [CI] = 25 to 3100), head and neck mass not described as lymphadenopathy (OR 260, 95% CI = 21 to 3200), other mass (OR 12, 95% CI = 4.4 to 35), thrombocytosis (OR 6.0, 95% CI = 2.6 to 14), raised inflammatory markers (OR 5.2, 95% CI = 3.0 to 9.0), and low full blood count (OR 2.8, 95% CI = 1.6 to 4.8). Lymphadenopathy per se has a positive predictive value (PPV) of 5.6% for HL in patients aged �60 years. Conclusion Consistent with secondary care findings, lymphadenopathy is the clinical feature with the highest risk of HL in primary care and warrants urgent investigation.

Item Type: Article
Subjects: Research Publications
Departments: College of Health and Behavioural Sciences > North Wales Centre for Primary Care Research
Date Deposited: 15 Jul 2015 02:35
Last Modified: 23 Sep 2015 02:47
ISSN: 0960-1643
URI: http://e.bangor.ac.uk/id/eprint/3856
Identification Number: DOI: 10.3399/bjgp15X684805
Publisher: Royal College of General Practitioners
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