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Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records.

Published version
Peer-reviewed

Type

Article

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Authors

Abel, Gary A 
Hamilton, William 
Singh, Hardeep 
Walter, Fiona M 

Abstract

INTRODUCTION: Sub-optimal use or interpretation of imaging investigations prior to diagnosis of certain cancers may be associated with less timely diagnosis, but pre-diagnostic imaging activity for urological cancer is unknown. METHOD: We analysed linked data derived from primary and secondary care records and cancer registration to evaluate the use of clinically relevant imaging tests pre-diagnosis, in patients with bladder and kidney cancer diagnosed in 2012-15 in England. As pre-diagnostic imaging activity increased from background rate 8 months pre-diagnosis, we used logistic regression to determine factors associated with first imaging test occurring 4-8 months pre-diagnosis, considering that such instances may reflect possible missed opportunities for expediting the diagnosis. RESULTS: 1963 patients with bladder or kidney cancer had at least one imaging test in the 8 months pre-diagnosis. 420 (21%) of patients had their first imaging test 4-8 months pre-diagnosis, that being ultrasound, CT and X-ray in 48%, 43% and 9% of those cases, respectively. Factors associated with greater risk of a first imaging test 4-8 months pre-diagnosis were kidney cancer, diagnosis at stages other than stage IV, first imaging having been an X-ray, test requested by GP and absence of haematuria before the imaging request. CONCLUSION: About 1 in 5 patients with urological cancers receive relevant first imaging investigations 4-8 months prior to diagnosis, which may represent potential missed diagnostic opportunities for earlier diagnosis.

Description

Keywords

Bladder cancer, Diagnostic delay, Early diagnosis, Imaging test, Kidney cancer, Adult, Electronic Health Records, Female, Humans, Kidney Neoplasms, Longitudinal Studies, Male, Primary Health Care, Urinary Bladder Neoplasms

Journal Title

Cancer Epidemiol

Conference Name

Journal ISSN

1877-7821
1877-783X

Volume Title

66

Publisher

Elsevier BV