Red flags to screen for tumours in patients with neck pain: A scoping review

Introduction: Neck pain is a prevalent condition that can occasionally indicate serious underlying pathologies, such as tumours. Red flags are clinical indicators used to identify patients at risk of such conditions. This scoping review systematically maps and summarizes the literature on red flags for tumours in patients presenting with neck pain in primary care, highlighting evidence gaps and priorities for future research. Methods: A comprehensive search across four databases up to June 2025 targeted studies on patients of any age or gender presenting with neck pain as the primary complaint and a final diagnosis of a tumour. Only studies conducted in primary care were included, with no time or geographical restrictions. Data were synthesized quantitatively and thematically. Results: From 10,211 initial records, 25 studies met the inclusion criteria, all being case reports. The most frequently reported red flags were severe neck pain, which may become progressive and constant, neurological signs and symptoms, and nocturnal neck pain. However, inconsistencies in reporting were observed: many commonly discussed red flags were absent from case reports, while some red flags highlighted in case reports are not extensively covered in the literature. Conclusion: Evidence on red flags for tumours in patients with neck pain in primary care remains fragmented. While certain red flags were frequently reported, their clinical utility is limited by inconsistent reporting and a lack of robust evidence. Further research is needed to standardize red flags and assess their diagnostic accuracy to improve early tumour detection in patients with neck pain.