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Heartburn and indigestion ‘indicate cancer’

GPs should assess the risk of pancreatic and gastro-oesophageal cancer in patients who present with heartburn and indigestion, say UK researchers.

In an analysis published in the March issue of British Journal of General Practice, researchers found patients presenting with indigestion had up to a four-fold increase in risk for pancreatic and gastro-oesophageal cancer.

A recent study showed significant delays for pancreatic and stomach cancers, with patients more likely to have had three or more pre-referral consultations with their GP.

The authors of this analysis said the data has been included in their QCancer risk score and could be used by GPs to assess the risk of cancer in patients presenting with dyspepsia or indigestion.

Their analysis looked at UK general practice records and found that females who presented to their GP with heartburn had a 2.5-fold increased risk of pancreatic cancer and a 2.2-fold increased risk of gastro-oesophageal cancer.

Females with indigestion, but no mention of heartburn, had a 4.3-fold increase in gastro-oesophageal cancer and a 3.8-fold increase in pancreatic cancer. The pattern for males was similar.

Study leader Professor Julia Hippisley-Cox, professor of epidemiology and general practice at the University of Nottingham and a GP in the city, said: ‘Both heartburn and indigestion were independently associated with risk of gastro-oesophageal cancer and also pancreatic cancer in both males and females.'

But Professor Roger Jones, emeritus professor of general practice at King's College London and president of the Primary Care Society for Gastroenterology, said GPs should assess other signs of cancer as dyspepsia and heartburn were likely to have a low predictive value.

‘The risk context for these upper gastrointestinal symptoms needs to include age - with the onset of new dyspepsia/heartburn at the age of 50 or so being much more of a red flag – and the presence of other alarm features, such as dysphagia, persistent pain, weight loss and anaemia.'

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