Unexpected weight loss warrants investigation for cancer in male ever smokers

1. Unexpected weight loss, in male ever smokers aged 50 and older, meets the 3% predictive value for warranting a cancer investigation.

Evidence Rating Level: 2 (Good)

Unexpected weight loss (UWL) is reported in 1.5% of adults seeing a primary healthcare provider. Past studies have found associations between UWL and early or late stage cancers, including lymphoma, pancreatic, and cancers of unknown primary. Furthermore, compared to individuals with no UWL, men are three times as likely and women twice as likely to be diagnosed with cancer within three months of UWL. However, due to a lack of clinical guidelines in the UK, physicians have responded in vastly different ways when a patient presents with UWL, from taking no action at all to ordering extensive investigations to detect cancer. The purpose of this diagnostic accuracy study was to determine a predictive value of UWL for cancer, when taking into account patients’ sex, smoking status, and symptoms. According to the national health institute in the UK, a positive predictive value (PPV) of 3% would be indicative of requiring further investigations for cancer. The study analyzed the records of 63,973 patients from a national database in the UK. These patients had all presented with UWL sometime between 2000 and 2012. The PPV for a cancer diagnosis within six months of UWL was higher for older patients and ever smokers. Upon breakdown by sex, PPV was higher in male patients. Specifically, male ever smokers aged 50+ with UWL met the 3% threshold (PPV=3.06, 95% CI 2.62 to 3.55), whereas males aged 60+ with no other symptoms besides UWL also met the threshold (PPV=3.00, 95% CI 2.70 to 3.33). Furthermore, the PPV of UWL is greater than 3% when patients have concurrent symptoms, including abdominal pain, appetite loss, abdominal mass, jaundice, low albumin levels, and raised white cell counts. This study’s findings have implications for guiding physicians on when UWL may be sufficient to warrant an investigation for cancer.

Click to read the study in BMJ

Image: PD

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