Stapley S et al. – Most previously reported symptoms of pancreatic cancer were also relevant in primary care. Although predictive values were small – apart from jaundice – they provide a basis for selection of patients for investigation, especially with multiple symptoms.

• A case–control study using electronic primary care records identified and quantified the features of pancreatic cancer.
• Cases, aged 40 in the General Practice Research Database, UK, with primary pancreatic cancer were matched with controls on age, sex and practice.
• Putative features of pancreatic cancer were identified in the year before diagnosis.
• Odds ratios (OR) were calculated for features of cancer using conditional logistic regression.
• Positive predictive values (PPV) were calculated for consulting patients.

• In all, 3635 cases and 16459 controls were studied.
• Nine features were associated with pancreatic cancer (all P<0.001 except for back pain, P=0.004); jaundice, OR 1000 (95% confidence interval (CI) 4302500); abdominal pain, 5 (4.4, 5.6); nausea/vomiting, 4.5 (3.5, 5.7); back pain, 1.4 (1.1, 1.7); constipation, 2.2 (1.7, 2.8); diarrhoea, 1.9 (1.5, 2.5); weight loss, 15 (11, 22); malaise, 2.4 (1.6, 3.5); new-onset diabetes 2.1 (1.7, 2.5).
• Positive predictive values for patients aged 60 were <1%, apart from jaundice at 22% (95% CI 14, 52), though several pairs of symptoms had PPVs >1%.