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GPs ‘should use simple blood tests’ to improve early diagnosis of multiple myeloma

GPs should use simple blood tests to support symptoms when diagnosing patients with multiple myeloma, in order to improve early detection rates, researchers have said.

The research team from the University of Exeter and University of Oxford analysed symptom prevalence and blood tests in 2,700 myeloma patients, and found that plasma viscosity and erythrocyte sedimentation rate are the best markers to support symptoms.

They said that using simple blood tests in patients with back pain, rib pain, chest pain, and recurrent chest infections could see patients diagnosed faster.

The researchers aimed to identify which blood tests are useful in determining a diagnosis of myeloma, a cancer characterised by numerous non-specific symptoms which results in diagnostic delays.

The matched case-control study, set in UK primary care, used routinely collected data from the Clinical Practice Research Datalink to analyse symptom prevalence and blood tests up to five years before diagnosis in 2,703 cases and 12,157 matched controls.

The paper, published in the BJGP, found that in the year before diagnosis 85% of patients with myeloma had an abnormal erythrocyte sedimentation rate (ESR) compared with 46% of controls, 81% had an abnormal plasma viscosity (PV) compared with 41% of controls, and 46% had an abnormal C-reactive protein (CRP) compared with 37% of controls.

They also reported that back pain, rib pain, chest infections, chest pain, and nosebleed, became more common in patients with myeloma compared with controls at around two years before diagnosis.

And symptoms suggesting advanced disease such as fractures, weight loss, and nausea, were more common up to one year before diagnosis, especially within the last three months.

Researchers said: ‘The results of this study suggest that the best inflammatory markers to supplement symptoms of myeloma are plasma viscosity and erythrocyte sedimentation rate, while C-reactive protein is unhelpful.

‘In addition, the combination of a normal haemoglobin and plasma viscosity can be used to rule out the disease on patients currently being tested in primary care.’

The team added: ‘Myeloma diagnosis could potentially be expedited by the use of simple blood tests in patients with back pain, rib pain, chest pain, and recurrent chest infections, which have been identified as early presentations of myeloma.’

MPs called for GPs to order more blood test earlier this year, arguing that to speed up diagnosis GPs should instigate blood cancer investigations for all patients who display one or more symptom.