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High plasma viscosity symptoms7/24/2023 These are often performed as a ‘rule-out’ test by clinicians trying to exclude serious underlying disease, including cancer. One triaging tool increasingly used in clinical practice is inflammatory marker tests, with the three most commonly used in UK practice being C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and plasma viscosity (PV). 4, 5, 6 GPs need to triage patients with low-risk symptoms to identify those needing further investigations, using additional ‘clues’ from history, examination and investigations. When patients present with high-risk symptoms, GPs in England can refer via urgent cancer referral pathways, but many patients with cancer present with low-risk (but not no-risk) symptoms. 2, 3 Cancer diagnosis in primary care can be challenging many of the early symptoms are non-specific and can be difficult to differentiate from the symptoms of common benign conditions. 1 Early diagnosis is important, with delayed diagnosis associated with more advanced stage at diagnosis and decreased survival. However, inflammatory markers have a poor sensitivity for cancer and are therefore not useful as ‘rule-out’ test.Ĭancer is common-affecting 50% of the UK population during their lifetime. ConclusionĬancer should be considered in patients with raised inflammatory markers. Sensitivities for cancer were 46.1% for CRP, 43.6% ESR and 49.7% for PV. Men over 50 and women over 60 with raised inflammatory markers have a cancer risk which exceeds the 3% NICE threshold for urgent investigation. Cancer risk is greater with higher inflammatory marker levels, with older age and in men risk rises further when a repeat test is abnormal but falls if it normalises. Primary care patients with a raised inflammatory marker have a one-year cancer incidence of 3.53% (95% CI 3.37–3.70), compared to 1.50% (1.43–1.58) in those with normal inflammatory markers, and 0.97% (0.87–1.07) in untested controls. Primary outcome was one-year cancer incidence. MethodsĬohort study of 160,000 patients with inflammatory marker testing in 2014, plus 40,000 untested matched controls, using Clinical Practice Research Datalink (CPRD), with Cancer Registry linkage. This study examined the diagnostic utility of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and plasma viscosity) for cancer diagnosis in primary care. Early identification of cancer in primary care is important and challenging.
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