Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review.

ABSTRACT

OBJECTIVES: The aim of this study was to quantify the risk of pancreatic cancer in patients presenting in primary care with symptoms that may indicate pancreatic cancer. METHODS: We searched MEDLINE, PreMEDLINE, EMBASE, the Cochrane Library, Web of Science, and ISI Proceedings (1980 to August 2014) and PsychINFO (1980 to May 2013) for diagnostic studies of symptomatic adult patients in primary care. Study quality was assessed using QUADAS-II, and data were extracted to calculate the positive predictive values (PPVs) of symptoms, singly or in combination, for pancreatic cancer. RESULTS: Eight studies with 3,438,363 patients were included. The PPV of jaundice was more than 4.1% in patients 40 years or older and increased with age, although only 30% of patients reported jaundice. The PPVs of other single symptoms were low, with the highest PPV being 1% for repeated attendance with abdominal pain in patients 60 years or older. Excluding jaundice, symptom combinations with high PPVs were those including weight loss, ranging from 1.5% to 2.7% in patients 60 years or older, apart from when weight loss was combined with malaise (PPV, 0.9%). CONCLUSION: The only high-risk feature of pancreatic cancer in primary care was jaundice, and this clearly warrants investigation. Weight loss accompanied by a second symptom may warrant investigation, although this would probably require abdominal computed tomography.