CVD risk tools could be repurposed to predict cancer risk, researchers say
Cardiovascular risk tools could be repurposed to predict the chance of several cancers, say researchers who tested them on a UK population.
Among adults aged 40 to 84, tools such as QRISK3 estimated the 10-year risk of common cancer types – including bowel, prostate and breast cancer – about as well as specialist cancer risk calculators.
A team at University College London found that for several other cancers, including kidney, laryngeal and gastro-oesophageal cancer, the CVD risk predictors performed about the same or better than they do for heart attack and stroke.
They noted that age, smoking and blood pressure are the strongest predictors of cancer risk – all factors including in CVD prediction tools.
Alongside QRISK3 they tested three other tools more commonly used in Europe in a cohort of Biobank participants and GP practice data.
Reporting their findings in the European Journal of Cancer, they said that after recalibration, the models could be used to inform cancer prevention and guide risk-stratified monitoring.
Tools for predicting future risk of cancer, such as QCancer, are available but are not widely used, they noted, compared with CVD risk calculators which are embedded into GP systems.
Data was analysed from more than five million people in total, with researchers comparing the models’ risk estimates with actual occurrences of heart disease and cancer in people aged 40 to 84 over a 10-year period.
The researchers showed that the repurposed CVD risk tools had comparable performance to the QCancer for ‘many common cancer types with established or emerging screening programmes, such as colorectal, breast, and prostate cancer’.
For lung cancer QCancer was a more accurate prediction tool but only in people who smoked. In people with no history of smoking, they performed the same.
Age, smoking history and blood pressure are well-established risk factors for many types of cancers, as well as for CVD, which is a plausible explanation for why the repurposed CVD models also did well when predicting cancer, they said.
Study lead Dr Sam Quill, a researcher in the UCL Institute of Cardiovascular Science, explained that blood pressure may not cause cancer directly but it is likely to be linked to other factors that increase cancer risk, such as physical inactivity and excessive alcohol intake
Dr Quill said: ‘Detecting cancer early through screening is important and is what health systems currently focus on, but there is also more we could do to prevent cancer from developing in the first place.
‘In the UK, we currently offer statins to people at higher risk of heart disease using the QRISK3 tool. Our study suggests the risk of certain cancers could be estimated at the same time.
‘However, the value of these tools in cancer prevention needs to be weighed carefully against wider efforts to reduce cancer risk for everyone. More research is needed to explore which approach and which interventions work best.’
Professor Azeem Majeed, a GP and head of the department of primary care and public health at Imperial College London, told Pulse that before introducing this into routine practice, GPs would need evidence that identifying people in this way ‘leads to interventions that improve outcomes, is cost-effective and does not result in unnecessary anxiety or over-investigation’.
He said: ‘Cardiovascular risk calculators, such as QRISK3, are based on risk factors such as age, smoking and obesity. These are also important determinants of several common cancers.
‘From a clinical perspective, I think the greatest value is not that QRISK3 could become a cancer prediction tool in its own right but that it provides another opportunity to discuss prevention in a broader way.
‘When a GP is discussing cardiovascular risk with a patient, the conversation could be widened to explain that measures such as stopping smoking, maintaining a healthy weight, being physically active and limiting alcohol intake will reduce the risk of both cardiovascular disease and several cancers.
‘Whether we should use cardiovascular risk scores to offer additional cancer-specific interventions is less clear.
‘Further research is needed before these tools should be repurposed for cancer prevention or risk-stratified monitoring.
‘Overall, I see this work as reinforcing the importance of a prevention-focused approach in primary care. Rather than thinking about heart disease and cancer separately, it reminds us that they (and other conditions such as dementia) share many modifiable risk factors and that tackling these benefits patients across a range of chronic diseases.’
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