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Microcytosis (smaller than normal red blood cells) has previously been identified as a possible early risk marker for some cancers. However, the role of microcytosis across all cancers has not been fully investigated.

To examine cancer incidence in a cohort of patients with microcytosis, with and without accompanying anaemia.

Cohort study of patients aged ≥40 years using UK primary care electronic patient records.

The 1-year cancer incidence was compared between cohorts of patients with a mean red cell volume of <85 femtolitres (fL) (low) or 85–101 fL (normal). Further analyses examined sex, age group, cancer site, and haemoglobin values.

Of 12 289 patients with microcytosis, 497 had a new cancer diagnosis within 1 year (4.0%, 95% confidence interval [CI] = 3.7 to 4.4), compared with 1465 of 73 150 without microcytosis (2.0%, CI = 1.9 to 2.1). In males, 298 …