Alarm symptoms of upper gastrointestinal cancer and contact to general practice – A population-based study

Abstract

Introduction. Survival of upper gastrointestinal (GI) cancer depends on early stage diagnosis. Symptom-based guidelines and fast-track referral systems have been implemented for use in general practice. To improve diagnosis of upper GI cancer, knowledge on prevalence of alarm symptoms in the general population and subsequent healthcare-seeking is needed. Material and methods. A nationwide study of 100,000 adults, who were randomly selected from the general population were invited to participate in an internet-based survey. People aged ≥45 years were included in this study. Items regarding experience of specific and nonspecific alarm symptoms of upper GI cancer within the preceding 4 weeks and contact to general practitioner (GP) were included. Results. Of the 60,562 subjects aged ≥45 years, 33,040 (54.6%) completed the questionnaire. The prevalence of the specific alarm symptoms ranged between 1.1% (“repeated vomiting”) and 3.4% (“difficulty swallowing”). Women had higher odds of experiencing “repeated vomiting” and “persistent and recent-onset abdominal pain”, but lower odds of experiencing “upper GI bleeding”. The proportion of people contacting their GP with each of the four specific alarm symptoms ranged from 24.3% (“upper GI bleeding”) to 39.9% (“repeated vomiting”). For each combination of two specific alarm symptoms, at least 52% contacted their GP. Conclusion. The specific alarm symptoms of upper GI cancer are not very prevalent in the general population. The proportion of GP contacts with each of the four specific symptoms varied between 24.3% and 39.9%. The proportion of GP contacts was higher in the older age and with combinations of two symptoms.

Key Words:

• Esophageal disorders
• gastroduodenal clinical
• general

Acknowledgments

This survey was conducted in collaboration between University of Southern Denmark and Aarhus University. The project is part of the research portfolio at the Research Centre for Cancer Diagnosis in Primary Care and is financially supported by the Novo Nordisk Foundation and the Danish Cancer Society. The questionnaire on which the study is based was developed by the authors in collaboration with Kirubakaran Balasubramaniam, Sandra Elnegaard, Anette Fischer Pedersen, Rikke Sand Andersen, and Peter Vedsted. The authors would like to thank Lise Keller Stark for proofreading the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.