Incidence of prostate, breast, lung and colorectal cancer following new consultation for musculoskeletal pain: A cohort study among UK primary care patients

Abstract

Musculoskeletal pain has been linked with subsequent cancer. The objective was to investigate associations between pain sites and specific cancers, and investigate the hypothesis that musculoskeletal pain is an early marker, rather than cause, of cancer. This was a cohort study in the General Practice Research Database. From a cohort of 46,656 people aged ≥50 years with a recorded musculoskeletal problem in 1996 but not during the previous 2 years, patients with a new consultation for back, neck, shoulder or hip pain in 1996 were selected and compared with 39,253 persons who had had no musculoskeletal consultation between 1994 and 1996. Outcome was incidence of prostate, breast, lung and colorectal cancer up to 10 years after baseline consultation. Strongest associations with prostate cancer were in the first year of follow-up for males consulting initially with back (adjusted hazard ratio 5.42; 95% CI 3.31, 8.88), hip (6.08; 2.87, 12.85) or neck problems (3.46; 1.58, 7.58). These associations remained for back and neck problems over 10 years. Significant associations existed with breast cancer up to 5 years after consultation in females with hip problems, and with breast and lung cancer in the first year after presentation with back problems. Previously observed links between pain and cancer reflect specific associations between pain sites and certain cancers. One explanation is liability for bony metastases from primary sites, and that pain represents a potential early marker of cancer. However, older patients with uncomplicated musculoskeletal pain seen in clinical practice have a low absolute excess cancer risk. What's new? Studies have suggested that musculoskeletal pain may be linked to cancer, though whether pain is an early symptom or a cause of cancer has remained unclear. In this study, new back, hip, and neck problems were found to be associated with the later diagnosis of prostate, breast, and lung cancer, mostly in the first year after baseline musculoskeletal consultation. However, risk of cancer is low and the association may be explained by liability of bony metastases from primary cancer sites, with pain being an early marker for disease. Copyright © 2013 UICC.