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.
Highlights
Population-based studies from the UK have reported links between self-reported musculoskeletal pain and subsequent onset of cancer up to 8 years later, an association stronger for widespread than regional pain and for prostate and breast rather than other sites of cancer.[1,2,3] A study based on a Finnish population though failed to confirm these findings.[4]
We have investigated whether there are specific links between primary care consultations for new musculoskeletal problems and individual cancers, what happens to any such risks over time, and whether they could be explained by concomitant widespread pain
As reported previously 48,206 persons with a new consulting episode of musculoskeletal problems were identified from 179 general practices, with 40,254 persons in the comparison group of persons who had not had such an episode.[5 1,550] persons with a new musculoskeletal problem and 1,001 from the comparison group were excluded on the basis of having a prior record of cancer. 37,561 (81%) of the 46,656 remaining persons with a new musculoskeletal episode consulted for a single, specified region
Summary
Population-based studies from the UK have reported links between self-reported musculoskeletal pain and subsequent onset of cancer up to 8 years later, an association stronger for widespread than regional pain and for prostate and breast rather than other sites of cancer.[1,2,3] A study based on a Finnish population though failed to confirm these findings.[4]. In our study of mortality in older adults following consultation for a new musculoskeletal problem in primary care, we confirmed an elevated risk of any cancer during 10 years of follow-up in these patients, but only in patients presenting with a back, hip, neck or shoulder problem.[5] This pattern, in contrast to the population studies, suggests that such pains may be an early symptom of a developing cancer rather than some general component of chronic pain being a cause of. We have investigated whether there are specific links between primary care consultations for new musculoskeletal problems and individual cancers, what happens to any such risks over time, and whether they could be explained by concomitant widespread pain
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