Isolated Headache is Not a Reliable Indicator for Brain Cancer: the 2-week Wait Pathway for Suspected CNS Malignancies

Overview

Journal Clin Med (Lond)

Specialty General Medicine

Date 2021 Dec 4

PMID 34862227

Citations 2

Authors

Bryan Ceronie

Thomas Hart

Daniel Belete

Lucille Ramani

Anish Bahra

Affiliations

Soon will be listed here.

Abstract

Introduction: The UK uses the 2-week-wait (2WW) pathway for rapid access to cancer services. It is unclear whether this is effective for brain cancer.

Methods: We retrospectively analysed all 2WW referrals for brain cancer between 2009 and 2016 in a district general neurology department. We compared clinical presentations to national guidelines and diagnoses of brain cancer.

Results: Of the 153 cases analysed, four brain cancers were identified: two glioblastomas and two metastases. Headaches were the most common referral. The end diagnosis was mostly migraine. The highest positive predictive value was for behavioural/personality change (5.3%) and sub-acute neurological deficit (3.2%). There was no significant association between any symptom(s) and brain cancer.

Conclusion: The 2WW pathway is not effective in the diagnosis of brain cancer. Resources are better directed towards clinical research and treatment trials. Headache remains the most common reason for referral although it is not yet a reliable indicator of brain cancer.

Citing Articles

Novel screening tool for secondary headache in acute care-A pilot study.

Haider S, Shoai M, Shah R, Turner C, Bahra A Clin Med (Lond). 2024; 24(2):100005.

PMID: 38484439 PMC: 11091393. DOI: 10.1016/j.clinme.2023.100005.

Isolated headache is not a reliable indicator for brain cancer.

Mbizvo G, Larner A Clin Med (Lond). 2022; 22(1):92-93.

PMID: 35078804 PMC: 8813026. DOI: 10.7861/clinmed.Let.22.1.2.

References

Nicholl D, Appleton J . Clinical neurology: why this still matters in the 21st century. J Neurol Neurosurg Psychiatry. 2014; 86(2):229-33. PMC: 4316836. DOI: 10.1136/jnnp-2013-306881. View

Tengah D, Byrne P, Wills A . Urgent 2-week referrals for CNS/brain tumours: a retrospective audit. Clin Oncol (R Coll Radiol). 2003; 15(1):7-9. DOI: 10.1053/clon.2002.0133. View

Jang Y, Cho E, Choi H, Kim S, Park H . Diagnostic Neuroimaging in Headache Patients: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2019; 16(6):407-417. PMC: 6603699. DOI: 10.30773/pi.2019.04.11. View

Taylor T, Evangelou N, Porter H, Lenthall R . Primary care direct access MRI for the investigation of chronic headache. Clin Radiol. 2011; 67(1):24-7. DOI: 10.1016/j.crad.2011.02.006. View

Jones R, Rubin G, Hungin P . Is the two week rule for cancer referrals working?. BMJ. 2001; 322(7302):1555-6. PMC: 1120606. DOI: 10.1136/bmj.322.7302.1555. View

Webb A, Butterworth R . Determinants of clinical effectiveness and significant neurological diagnoses in an urgent brain cancer referral pathway in the United Kingdom. Clin Neurol Neurosurg. 2015; 132:37-40. DOI: 10.1016/j.clineuro.2015.02.014. View

Hamdan A, Mitchell P . The two-week wait guideline for suspected CNS tumours: a decade analysis. Br J Neurosurg. 2013; 27(5):642-5. DOI: 10.3109/02688697.2013.771725. View

Forsyth P, Posner J . Headaches in patients with brain tumors: a study of 111 patients. Neurology. 1993; 43(9):1678-83. DOI: 10.1212/wnl.43.9.1678. View

Schankin C, Ferrari U, Reinisch V, Birnbaum T, Goldbrunner R, Straube A . Characteristics of brain tumour-associated headache. Cephalalgia. 2007; 27(8):904-11. DOI: 10.1111/j.1468-2982.2007.01368.x. View

10.

Abernethy Holland A, Larner A . Central nervous system/brain tumour 2-week referral guidelines: prospective 3-year audit. Clin Oncol (R Coll Radiol). 2008; 20(2):201-2. DOI: 10.1016/j.clon.2007.10.015. View

11.

Uff C, Lawson D, Giles G, Bavetta S . The two-week waiting time standard for cancer: a neurosurgical perspective. Br J Neurosurg. 2006; 19(4):334-7. DOI: 10.1080/02688690500305365. View

12.

Sunde K, Cutsforth-Gregory J, Leep Hunderfund A . The Basic Four Approach to Clinical Neuroscience Instruction: Using Cognitive Load Theory to Enhance Case-based Learning. J Med Educ Curric Dev. 2019; 5:2382120518815698. PMC: 6311552. DOI: 10.1177/2382120518815698. View

13.

Mohammad H, Boardman J, Howell L, Mills R, Emsley H . Urgent referral for suspected CNS cancer: which clinical features are associated with a positive predictive value of 3 % or more?. BMC Neurol. 2016; 16(1):152. PMC: 5000444. DOI: 10.1186/s12883-016-0677-1. View

14.

Grant R, Dowswell T, Tomlinson E, Brennan P, Walter F, Ben-Shlomo Y . Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev. 2020; 9:CD013564. PMC: 8082957. DOI: 10.1002/14651858.CD013564.pub2. View

15.

Louis D, Ohgaki H, Wiestler O, Cavenee W, Burger P, Jouvet A . The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007; 114(2):97-109. PMC: 1929165. DOI: 10.1007/s00401-007-0243-4. View

16.

Friedman D, Quiros P, Subramanian P, Mejico L, Gao S, McDermott M . Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial. Headache. 2017; 57(8):1195-1205. PMC: 5799151. DOI: 10.1111/head.13153. View

17.

Lipton R, Stewart W . Migraine in the United States: a review of epidemiology and health care use. Neurology. 1993; 43(6 Suppl 3):S6-10. View

18.

Woldeamanuel Y, Cowan R . Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2016; 372:307-315. DOI: 10.1016/j.jns.2016.11.071. View

19.

Gori S, Morelli N, Maestri M, Fabbrini M, Bonanni E, Murri L . Sleep quality, chronotypes and preferential timing of attacks in migraine without aura. J Headache Pain. 2005; 6(4):258-60. PMC: 3452032. DOI: 10.1007/s10194-005-0201-2. View

20.

Morris Z, Whiteley W, Longstreth Jr W, Weber F, Lee Y, Tsushima Y . Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2009; 339:b3016. PMC: 2728201. DOI: 10.1136/bmj.b3016. View