Incidentally diagnosed cancer and commonly preceding clinical scenarios: a cross-sectional descriptive analysis of English audit data.
OBJECTIVES
Cancer can be diagnosed in the absence of tumour-related symptoms, but little is known about the frequency and circumstances preceding such diagnoses which occur outside participation in screening programmes. We aimed to examine incidentally diagnosed cancer among a cohort of cancer patients diagnosed in England.


DESIGN
Cross-sectional study of national primary care audit data on an incident cancer patient population.


SETTING
We analysed free-text information on the presenting features of cancer patients aged 15 or older included in the English National Audit of Cancer Diagnosis in Primary Care (2009-2010). Patients with screen-detected cancers or prostate cancer were excluded. We examined the odds of incidental cancer diagnosis by patient characteristics and cancer site using logistic regression, and described clinical scenarios leading to incidental diagnosis.


RESULTS
Among the studied cancer patient population (n=13 810), 520 (4%) patients were diagnosed incidentally. The odds of incidental cancer diagnosis increased with age (p<0.001), with no difference between men and women after adjustment. Incidental diagnosis was most common among patients with leukaemia (23%), renal (13%) and thyroid cancer (12%), and least common among patients with brain (0.9%), oesophageal (0.5%) and cervical cancer (no cases diagnosed incidentally). Variation in odds of incidental diagnosis by cancer site remained after adjusting for age group and sex.There was a range of clinical scenarios preceding incidental diagnoses in primary or secondary care. These included the monitoring or management of pre-existing conditions, routine testing before or after elective surgery, and the investigation of unrelated acute or new conditions.


CONCLUSIONS
One in 25 patients with cancer in our population-based cohort were diagnosed incidentally, through different mechanisms across primary and secondary care settings. The epidemiological, clinical, psychological and economic implications of this phenomenon merit further investigation.
['Koo|Minjoung Monica|MM|0000-0001-9832-9872', 'Rubin|Greg|G|', 'McPhail|Sean|S|', 'Lyratzopoulos|Georgios|G|0000-0002-2873-7421']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D003430:Cross-Sectional Studies D004739:England D005260:Female D006801:Humans D033162:Incidental Findings D007680:Kidney Neoplasms D007938:Leukemia D016015:Logistic Models D008297:Male D008875:Middle Aged D009369:Neoplasms D013964:Thyroid Neoplasms D055815:Young Adult
primary care health services administration & management oncology pathology public health radiology & imaging