Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

Abstract

Background: Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated.

Aim: To examine pre-diagnostic patterns of results of abnormal blood tests in patients with bladder and renal cancer.

Design and setting: A retrospective cohort study using primary care and cancer registry data on patients with bladder and renal cancer who were diagnosed between April 2012 and December 2015 in England.

Method: The rates of patients with a first abnormal result in the year before cancer diagnosis, for 'generic' (full blood count components, inflammatory markers, and calcium) and 'organ-specific' blood tests (creatinine and liver function test components) that may lead to subsequent detection of incidental cancers, were examined. Poisson regression was used to detect the month during which the cohort's rate of each abnormal test started to increase from baseline. The proportion of patients with a test found in the first half of the diagnostic window was examined, as these 'early' tests might represent opportunities where further evaluation could be initiated.

Results: Data from 4533 patients with bladder and renal cancer were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic (for example, high inflammatory markers) and organ-specific tests (for example, high creatinine) started to increase from 6-8 months pre-diagnosis, with 25%-40% of these patients having an abnormal test in the 'early half' of the diagnostic window.

Conclusion: Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.

Keywords: bladder cancer; diagnostic tests, routine; early detection of cancer; primary health care; renal cancer; test utilisation.

Figure 1.

Rate of abnormal blood tests in the year prediagnosis, with dotted line signifying increase in rate from baseline for that particular test (only statistically significant results shown). ^{a a} Inflection line for high WCC and high platelets both occur (and therefore overlap) at 6 months pre-diagnosis. ALT = alanine transaminase. AST = aspartate aminotransferase. CRP = C-reactive protein. ESR = erythrocyte sedimentation rate. Hb = haemoglobin. LFT = liver function test. Plt = platelets. WCC = white cell count.