BACKGROUND Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis. METHODS In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I-III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms. FINDINGS We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1-3; eight of 584 patients) for abnormal mole to 80% (71-87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the "any other symptom" category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV. INTERPRETATION Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease. FUNDING UK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.

中文翻译：

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在诊断时呈现癌症症状和分期：来自基于人群的横断面研究的证据。

背景技术诸如症状意识运动之类的早期诊断干预越来越多地成为全球癌症控制策略的一部分。但是，如果靶向症状代表疾病的晚期，那么这些策略对改善癌症结局几乎没有影响。因此，我们旨在检查常见的癌症症状与诊断阶段之间的关联。方法在这项横断面研究中，我们分析了2014年英国国家癌症诊断审核中25岁及以上患有12种实体瘤（膀胱，乳腺，结肠，子宫内膜，喉，肺，黑色素瘤，口腔或口咽癌，卵巢癌，前列腺癌，直肠癌和肾癌）。我们考虑了20种常见症状，并使用logistic回归分析了它们与诊断阶段（TNM IV期与I-III期）的关联。对于每种症状，我们都将这些相关性评估为单一表现症状并与其他症状一起报告时的相关性。结果我们分析了7997例患者的数据。根据症状表现，诊断为IV期癌症的患者比例差异很大，从痣异常的1％（95％CI 1-3； 584名患者中的8名）到颈部肿块的80％（71-87； 84名患者中的84％） 。所检查的症状中的三个（颈部肿块，胸痛和背痛）始终与IV期癌症的发生率增加相关，无论是单独报告还是与其他症状相关，而痣，乳房肿块，绝经后出血异常则相反。和直肠出血。对于20种症状中的13种（异常痣，乳房肿块，绝经后出血，直肠出血，下尿路症状，血尿，排便习惯改变，声音嘶哑，疲劳，腹部疼痛，下腹部疼痛，体重减轻和任何其他症状”类别，超过IV％的其他阶段被诊断出超过50％的患者；在研究的20种症状中，有19种（除颈部肿块外）均被诊断为IV期以外的其他阶段。解释尽管特定的呈现症状与诊断的晚期阶段相比其他症状更密切相关，但对于大多数症状，仍有很大一部分患者被诊断为IV期以外的阶段。这些发现为针对常见癌症症状的早期诊断干预措施提供了支持，消除担心他们可能只是在加快晚期疾病的检测。英国卫生部资助的癌症意识，筛查和早期诊断政策研究室；和英国癌症研究。