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Predicting colorectal cancer risk in patients with rectal bleeding

Predicting colorectal cancer risk in patients with rectal bleeding
Predicting colorectal cancer risk in patients with rectal bleeding
Background Rectal bleeding is an important symptom of colorectal cancer but has low predictive value in primary care. Aim To determine which characteristics of rectal bleeding, along with other factors, are predictive of colorectal cancer. Design of study Observation study of patients with rectal bleeding referred to an open-access diagnostic clinic. Setting Primary care, southern England. Method Symptom data were collected, using a self-completed questionnaire. Logistic regression techniques were used to determine predictors of colorectal cancer. Results There were 604 patients in the study and 22 (3.6%, 95% confidence interval [CI] = 2.0% to 5.2%) were diagnosed with colorectal cancer. Significant predictors of colorectal cancer were found to be age (= 70 years: OR = 8.2, 95% CI = 2.1 to 31.8) and blood mixed with the stool (Likelihood ratio [LR] 1.5; adjusted OR = 3.8; 95% CI = 1.4 to 10.5). Presence of haemorrhoids associated with bright red bleeding not mixed with stool reduced the likelihood of cancer (OR = 0.4, 95% CI = 0.1 to 1.2) but did not eliminate it - a cancer was present in 2% of patients with these symptoms. Conclusion Patient-reported type of rectal bleeding as an isolated symptom has insufficient diagnostic value to be useful in general practice. By studying referred patients, we may even have overestimated its value. At best, it could be useful as a component of a composite symptom score to guide referral decisions
diagnosis, general practice, age, time, cancer-risk, colorectal neoplasms, risk, primary care, questionnaire, patient, population, general-practitioners, bowel-cancer, guidelines, cancer, early diagnosis, duration, prevalence, symptoms, care, consultation behavior, sigmoidoscopy, scoring system, colorectal cancer, general-practice, signs, decisions, colorectal-cancer
0960-1643
763-767
Robertson, R.
948e76d9-1cd5-4fc3-b12f-03dc823c7ae2
Campbell, C.
6ea5910b-6462-4c14-8ff7-2b70ce0bc530
Weller, D.P.
4fa29f26-81d9-4468-8746-df0c74804f28
Elton, R.
f1b318d9-46d7-4563-b242-07f4faf71460
Mant, D.
10e94981-cd2c-4e56-8a11-54d9fc107117
Primrose, J.
d85f3b28-24c6-475f-955b-ec457a3f9185
Nugent, K.
79fcb89d-6ff2-47b8-ac2c-2afb24954456
Macleod, U.
5cbb9a60-6e18-4cc1-b240-9fb9a7cbc8f2
Sharma, R.
e7c15bd5-d066-4290-996c-10952de3644e
Robertson, R.
948e76d9-1cd5-4fc3-b12f-03dc823c7ae2
Campbell, C.
6ea5910b-6462-4c14-8ff7-2b70ce0bc530
Weller, D.P.
4fa29f26-81d9-4468-8746-df0c74804f28
Elton, R.
f1b318d9-46d7-4563-b242-07f4faf71460
Mant, D.
10e94981-cd2c-4e56-8a11-54d9fc107117
Primrose, J.
d85f3b28-24c6-475f-955b-ec457a3f9185
Nugent, K.
79fcb89d-6ff2-47b8-ac2c-2afb24954456
Macleod, U.
5cbb9a60-6e18-4cc1-b240-9fb9a7cbc8f2
Sharma, R.
e7c15bd5-d066-4290-996c-10952de3644e

Robertson, R., Campbell, C., Weller, D.P., Elton, R., Mant, D., Primrose, J., Nugent, K., Macleod, U. and Sharma, R. (2006) Predicting colorectal cancer risk in patients with rectal bleeding. British Journal of General Practice, 56 (531), 763-767.

Record type: Article

Abstract

Background Rectal bleeding is an important symptom of colorectal cancer but has low predictive value in primary care. Aim To determine which characteristics of rectal bleeding, along with other factors, are predictive of colorectal cancer. Design of study Observation study of patients with rectal bleeding referred to an open-access diagnostic clinic. Setting Primary care, southern England. Method Symptom data were collected, using a self-completed questionnaire. Logistic regression techniques were used to determine predictors of colorectal cancer. Results There were 604 patients in the study and 22 (3.6%, 95% confidence interval [CI] = 2.0% to 5.2%) were diagnosed with colorectal cancer. Significant predictors of colorectal cancer were found to be age (= 70 years: OR = 8.2, 95% CI = 2.1 to 31.8) and blood mixed with the stool (Likelihood ratio [LR] 1.5; adjusted OR = 3.8; 95% CI = 1.4 to 10.5). Presence of haemorrhoids associated with bright red bleeding not mixed with stool reduced the likelihood of cancer (OR = 0.4, 95% CI = 0.1 to 1.2) but did not eliminate it - a cancer was present in 2% of patients with these symptoms. Conclusion Patient-reported type of rectal bleeding as an isolated symptom has insufficient diagnostic value to be useful in general practice. By studying referred patients, we may even have overestimated its value. At best, it could be useful as a component of a composite symptom score to guide referral decisions

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More information

Published date: 2006
Keywords: diagnosis, general practice, age, time, cancer-risk, colorectal neoplasms, risk, primary care, questionnaire, patient, population, general-practitioners, bowel-cancer, guidelines, cancer, early diagnosis, duration, prevalence, symptoms, care, consultation behavior, sigmoidoscopy, scoring system, colorectal cancer, general-practice, signs, decisions, colorectal-cancer

Identifiers

Local EPrints ID: 62901
URI: http://eprints.soton.ac.uk/id/eprint/62901
ISSN: 0960-1643
PURE UUID: d7bc4096-86c1-4be5-9e51-52442917c55a
ORCID for J. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 09 Sep 2008
Last modified: 17 Dec 2019 01:59

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