Certain Signs, Symptoms May Help Identify Lung Cancer Earlier

M. Alexander Otto, PA, MMS

June 16, 2022

The study was published on medrxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Patients in ambulatory care settings who are subsequently diagnosed with lung cancer show a pattern of symptoms and signs that distinguish them from other patients, often months before diagnosis.

Why This Matters

  • Most patients with lung cancer are diagnosed with stage 3 or 4 disease.

  • Uptake of low-dose CT screening for lung cancer remains low.

  • Identifying a pattern of signs and symptoms strongly linked to an impending lung cancer diagnosis can improve screening practices and potentially catch lung cancer sooner when it is more treatable.

Study Design

  • The team matched 698 patients with lung cancer diagnosed from 2012-2019 to 6841 controls to identify what 22 symptoms and signs are most strongly associated with a future lung cancer diagnosis.

  • Data came from electronic health records of ambulatory visits to the University of Washington in Seattle.

  • Cases and controls were matched by age, sex, smoking status, and type of ambulatory clinic visited.

Key Results

  • On multivariate analysis, 11 signs and symptoms were significantly associated with lung cancer up to 12 months before diagnosis: finger clubbing (odds ratio [OR], 50.1), lymphadenopathy (OR, 5.8), cough (OR 4,.7), hemoptysis (OR, 3.5), chest crackles or wheezes (OR, 3.2), weight loss (OR, 2.9), back pain (OR, 2.4), bone pain (OR, 2.3), shortness of breath (OR, 1.9), fatigue (OR, 1.8), and chest pain (OR, 1.4).

  • Of these, 7 were significantly associated with lung cancer 6 months prior to diagnosis: hemoptysis (OR, 3.2), cough (OR, 3.1), chest crackles or wheezes (OR, 3.1), bone pain (OR, 2.7), back pain (OR, 2.5), weight loss (OR, 2.1), and fatigue (OR, 1.6).

  • Fever, sleep changes, dizziness, and lack of appetite were significantly associated with higher odds of being a control.

  • The presence of chronic respiratory disease did not affect the results.  


  • Electronic health record data is subject to misclassification. 

  • A very broad definition of smoking (ever vs never) was used in matching.


  • The study was funded by Cancer Research UK and the National Cancer Institute, among others.

  • The investigators did not report any relevant disclosures.

This is a summary of a preprint research study, "Symptoms and signs of lung cancer prior to diagnosis: Comparative study using electronic health records," led by Maria Prado of the University of Washington in Seattle. The study has not been peer reviewed. The full text can be found at medrxiv.org.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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