“Red-Flag,” Clinical Exclusion, and Expected Follow-up Criteria by Cancer Type Used in Electronic Algorithms Applied to the Electronic Health Records of 118,400 Patients from April 20, 2011, to July 19, 2012
| Cancer | “Red-Flag” Criteria | Clinical Exclusion Criteria | Expected Diagnostic Evaluation |
|---|---|---|---|
| Lung cancer | Any of the following flagged by radiologist as suspicious for malignancy: ∙ Chest radiograph or chest CT scan | ∙ Age <30 years ∙ Prior history of lung cancer ∙ Terminal illness diagnosis ∙ Hospice/palliative care enrollment ∙ Prior tuberculosis diagnosis ∙ Pulmonary evaluation within last 6 months | Any of the following within 30 days after red-flag criteria: ∙ Pulmonary referral completed ∙ Lung procedure (biopsy, bronchoscopy, thoracic surgery) ∙ Repeat x-ray or CT scan |
| Colon cancer | Positive FOBT, or | ∙ Age <40 or >75 years ∙ Colonoscopy within 5 years (for positive FOBT) or 3 years (for hematochezia or IDA) prior to high-risk criteria met ∙ Prior history of colorectal cancer ∙ Prior total colectomy ∙ Terminal illness diagnosis ∙ Hospice/palliative care enrollment ∙ Upper GI bleed within 1 year before or 60 days after red-flag criteria are met Additional IDA-specific criteria include the following: ∙ Prior thalassemia diagnosis ∙ Hospitalization within 14 days before red-flag criteria met ∙ Surgery within 14 days before high-risk criteria met ∙ Menorrhagia diagnosis within 5 years before or 60 days after high-risk criteria met ∙ Other cause of bleeding within 1 year before or 60 days after high-risk criteria met ∙ Pregnant within 1 year before or 60 days after high-risk criteria met | ∙ Colonoscopy performed within 60 days after red-flag criteria |
| New hematochezia diagnosis or | |||
| Laboratory results consistent with IDA: ∙ Hemoglobin ≤11 g/dL ∙ Mean corpuscular volume ≤81 fL ∙ No ferritin ≥100 ng/mL in prior 12 months | |||
| Prostate cancer | PSA result of 4.1–15 ng/mL | ∙ Age <40 or >70 years ∙ Prior history of prostate cancer ∙ Prostate biopsy within prior 2 years ∙ Prostatitis diagnosis within 30 days before or 90 days after red-flag criteria met ∙ Terminal illness diagnosis ∙ Hospice/palliative care enrollment | Any of the following within 90 days after red-flag criteria: ∙ Repeat PSA performed ∙ Urology referral requested or completed ∙ Prostate biopsy performed |
CT, computed tomography; FOBT, fecal occult blood test; GI, gastrointestinal; IDA, iron-deficiency anemia; PSA, prostate-specific antigen. Reprinted with permission. © (2015) American Society of Clinical Oncology. All rights reserved. Murphy et al: J Clin Oncol 33(31), 2015: 3560–7.5