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Rare cancer could be detected earlier by GPs using simple blood tests

A combination of blood tests already used in GP surgeries could detect or rule out multiple myeloma.

A rare form of cancer could be detected earlier by GPs using simple blood tests, a new study suggests.

Researchers found that the combination of two blood tests frequently carried out in GP practices may rule out multiple myeloma – a form of bone marrow cancer – or prompt further investigations.

Symptoms of the disease are frequently non-specific, which means that it can be hard to diagnose the illness.

Delays in diagnosis, which affect a large proportion of patients, can lead to poorer outcomes for those affected by the disease.

Researchers examined British patients whose data was held in the Clinical Practice Research Datalink to find out whether blood tests are useful in suggesting or excluding a diagnosis of myeloma.

The experts from the University of Oxford, the University of Exeter and Chiddenbrook Surgery, Crediton, matched 2,703 cases to 12,157 control participants.

The study, published in the British Journal of General Practice, found that a simple combination of two blood parameters could be enough to diagnose patients.

We report a simple way a GP can check patients presenting symptoms such as back, rib and chest pain, or recurrent chest infections, and determine whether they have myeloma or not Prof Willie Hamilton, University of Exeter Medical School

Such blood tests are already routinely conducted in GP surgeries.

The authors found that GPs could simply rule out the disease among patients who had normal results on blood tests which either examine plasma viscosity (PV) or erythrocyte sedimentation rate (ESR) in combination with a test which examines normal haemoglobin.

They found that during the year before diagnosis, 85% of myeloma patients had an abnormal ESR compared with 46% of the control participants.

Meanwhile, 81% had an abnormal PV compared with 41% of controls.

The authors suggested that a system could be introduced into patients’ electronic health records to alert doctors to relevant symptoms or changes in blood parameters related to myeloma.

Constantinos Koshiaris, lead author of the study from Oxford University, said: “The combination of levels of haemoglobin, the oxygen carrier in the blood, and one of two inflammatory markers (erythrocyte sedimentation rate or plasma viscosity) are a sufficient test to rule out myeloma.

“If abnormalities are detected in this test, it should lead to urgent urine protein tests which can help speed up diagnosis.”

Professor Willie Hamilton, of the University of Exeter Medical School, added: “More timely treatment could significantly improve survival rates for this disease.

“We report a simple way a GP can check patients presenting symptoms such as back, rib and chest pain, or recurrent chest infections, and determine whether they have myeloma or not.”

Meanwhile, a separate article published in the same journal suggests that GPs should have better access for referring their patients directly for cancer tests, rather than going through a specialist first.

The authors said that in the past GPs have acted as gatekeepers who have managed the referral rate into secondary care, with the specialist then deciding on investigations.

They examined previous studies which looked into the effectiveness of direct access testing for GPs.

The evidence suggests in most cases it is just as good, the authors said.

Meanwhile, the time taken for the test to take place was reduced.

After examining 60 papers on the issue, the experts from the University of Oxford concluded: “GP direct access testing for symptoms that could be indicative of cancer has previously been criticised for increasing testing and decreasing diagnostic yield.

“This systematic review did not support these concerns.”

They added: “The time between test request and test performance was reduced, and GP direct access testing achieved consistently higher GP and patient satisfaction.”

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