Who is this information intended for?
This information is primarily intended for doctors and nurses working in general practice and for academics who are interested in the underlying research. Patients are welcome to read this information and use the calculator together with their doctor so that any symptoms or concerns can be addressed within a health care setting. All medical decisions need to be taken by a patient in consultation with their doctor. The authors and the sponsors accept no responsibility for clinical use or misuse of this score.
What is QCancer®?
QCancer® gives two kinds of score:
- Today's score works out the risk of a patient having a current but as yet undiagnosed cancer, taking account of their risk factors and current symptoms.
- The 10-year score (QCancer®-10yr) works out the risk of a patient developing cancer over the next 10 years, given their individual risk factors.
Neither gives a diagnosis of cancer, but a risk. You can find out more about how to use QCancer® in a clinical setting here (PDF).
Who has developed it?
The algorithms have been developed by Professor Julia Hippisley-Cox and Dr Carol Coupland for ClinRisk Ltd and are based on routinely collected data from many thousands of GPs in the UK who have contributed data to QResearch for medical research.
Why has the study been done?
The UK has one of the worst records for cancer in Europe with late diagnoses and poor survival. Earlier diagnosis of cancer is likely to improve with more targeted investigation of symptomatic patients. Risk assessment tools have the potential to help identify patients at risk of cancer for early referral and investigation although previous tools have tended to focus on individual cancers. However, patients commonly present with symptoms and symptoms map to multiple cancers. This means that a risk assessment tool which takes account of multiple symptoms and risk factors to predict risk of multiple cancers is likely to better help doctors assess which patients need referral or investigation. GP Research databases such as QResearch are particularly good for developing this type of tool since they contain good data on many of the relevant variables and types of cancer. They also reflect the kinds of patients and setting where such tools need to be used. We therefore decided to develop and test a new algorithm to estimate an individual's overall cancer risk and risk of each type of cancer taking account of multiple symptoms and risk factors which the patient is likely to know or which are routinely recorded in GP computer systems.
The 10-year score builds on this work. It quantifies the absolute risk of future cancer over a 10 year period using predictor variables recorded in the patient's primary care electronic record. In particular, we were interested to quantify the absolute risk of cancer in
- patients with a positive family history of specific cancers, previous cancers or a chronic disease which might increase cancer risk and might require additional surveillance and
- those with potentially modifiable risk factors (such as smoking and alcohol) for whom quantification of absolute risk might be useful to support efforts to lower risk.
This research to derive and test the 10-year algorithms has been undertaken using the QResearch database linked to cancer registrations, mortality and hospital episode statistics.
How has it been developed?
The science underpinning the development of these tools is published in the British Journal of General Practice (today's score) and BMJ Open (the 10-year score), and can be found on the publications page. In summary, we used the QResearch database, a very large electronic research database of anonymised health records, to undertake the study. We identified a large group of patients aged 25-89 years old and followed them up, over a two year period for today's score and a 10 year period for the 10-year score, to see which patients got cancer, which patients didn't, what type of cancer they had and what factors were associated with cancer. We then used this information to develop the predictive models which form the basis of the calculator.
How has it been tested?
The QCancer® tools have been tested on another group of patients from a separate group of practices. For today's score, the results found it was very good at spotting which patients were most likely to have cancer - for example 54% of women and 59% of men subsequently diagnosed with cancer were in the top 10 per cent of women predicted to be most at risk. Additional validation studies have been undertaken, including research by an independent team of academics at Oxford University using a completely separate database of general practices using a different computer system; these are listed on the publications page. The 10-year score was found to be very good at spotting which patients were most likely to develop cancer, and accurate in terms of the level of risk which it predicts.
What cancers does it predict?
Today's score predicts the overall risk of having a cancer as yet undiagnosed and the risk of each of the following types:
- Colorectal cancer
- Gastro-oesophageal cancer
- Pancreatic cancer
- Blood cancers
- Lung cancer
- Renal tract cancer
- Testicular cancer
- Prostate cancer
- Breast cancer
- Uterine cancer
- Ovarian cancer
- Cervical cancer
- Other cancer - this includes the rarer cancers which are not in the above list.
The 10-year score predicts the risk of developing each of the following types over the next 10 years:
- Blood cancers
- Breast cancer
- Colorectal cancer
- Oesophageal/gastric cancer
- Lung cancer
- Oral cancer
- Ovarian cancer
- Pancreatic cancer
- Renal cancer
- Prostate cancer
- Uterine cancer
A cancer the patient has already been diagnosed with has no 10-year score.
For further information on particular types of cancer see
What symptoms and risk factors are included in the algorithms?
Please see the calculator itself for the symptoms and risk factors. It is important to note that the symptoms are ones which the patient has considered significant enough to consult the GP about. If you are a patient and have any of the symptoms on the calculator or are concerned, then you should consult your family doctor.
How can the calculator be implemented?
The calculator is available as a website. It can also be built into clinical computer systems so that it can be used at the point of care in a clinical setting.