09/14/2009 - Articles

Alarm symptoms and cancer diagnoses

By: Susan Aldridge, medical journalist, PhD


Alarm – or ‘red flag’ – symptoms are the ones that should prompt you to seek medical help without delay.  They include symptoms like blood in the urine (haematuria), coughing up blood (haemoptysis), difficulty in swallowing (dysphagia) and rectal bleeding. 

They are red flag symptoms because they may indicate cancer of the bladder, lung, esophagus or colon, respectively.  But there are many other non-cancer causes, for red flags – with, for instance, haemorrhoids being the most common cause of rectal bleeding symptoms.

Researchers in London now report on what happens when doctors investigate those worrying red flag symptoms.  They drew on the UK general practice database to identify three quarters of a million people who presented with a first episode of a red flag symptom and then looked at how long it took to diagnose.  Overall, a diagnosis, of cancer or a non-cancer condition, was given within 90 days of presenting with the symptom in about one in five cases.  The proportion had risen to about a half within three years. 


For the one in five who got a diagnosis of their red flag symptoms, their minds were either put at rest, or their cancer was caught early.  Given that referral to a specialist and futher tests might be needed,  a period of 90 days seems reasonable for resolution of the cause of the symptoms.   But around half of the patients had not had an answer within three years as to the cause of their symptoms.  In some cases, the condition may have cleared up – for instance, a bladder infection may cause blood in the urine.  In others, the appropriate investigations may not have been done.  The researchers conclude that doctors shouldn’t just rule out cancer when someone presents with a red flag symptom.  They should consider whether it is a ‘yellow flag’ – that is, a symptom of a non-cancer condition but one that still needs treatment.  Trying for a diagnosis is better than watching waiting when it comes to red flag symptoms.


Jones R, Charlton J et al Alarm symptoms and identificaiton of non-cancer diagnoses in primary care: cohort study BMJ; August 29 2009; 339:491-493


Created on: 09/06/2009
Reviewed on: 09/14/2009

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