Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population‐based study

Abstract

Aim The incidence of colorectal cancer in the under 50s is increasing. In this national population‐based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. Method We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary‐care records. Results The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50–59, 2294 (31.4%) were aged 60–69 and 3345 (45.7%) were aged 70–79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60–69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red‐flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. Conclusion Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.

Incidence trends for twelve cancers in younger adults—a rapid review

“…As cancer is more common in the elderly, doctors are more inclined to suspect cancer in older patients [ 1 ] and younger patients are more likely than older people to have consulted with a doctor three or more time before referral [ 2 , 3 ]. Even when referred, younger patients may be referred through a less urgent route compared to older ones [ 4 ]. A delay in diagnosis may result in cancer progressing to a less curable stage.…”

Finding the needle in the haystack: the diagnostic accuracy of the faecal immunochemical test for colorectal cancer in younger symptomatic patients

“…Bowel symptoms in younger patients may be attributed by clinicians to common benign colorectal disease, such as rectal bleeding from haemorrhoids or abdominal pain from irritable bowel syndrome [9][10][11]. Unfortunately, younger patients who report non-specific symptoms but who have an underlying CRC may require multiple visits before referral for investigation, resulting in longer time to diagnosis [12][13][14][15]. A survey of EOCRC patients in the UK reported that 43% of patients required three or more visits to their primary care physician (PCP) before referral to secondary care for further investigation, and that 65% were initially given an incorrect diagnosis [11].…”

“…Patients themselves may not suspect their bowel symptoms may be due to cancer: in the same survey, 75% of patients did not suspect their symptoms were due to CRC, and 30% delayed seeing their PCP for up to 3 months [11]. The interval from referral to diagnosis in younger patients is significantly longer in younger patients in national UK data, probably due to an absence of criteria indicating urgent referral for suspected cancer [12]. National cohort data also report that EOCRC more commonly presents as an emergency, at a more advanced stage of diagnosis [12,14,16,17], although younger patients tend to have better survival than older patients [18,19].…”

“…The interval from referral to diagnosis in younger patients is significantly longer in younger patients in national UK data, probably due to an absence of criteria indicating urgent referral for suspected cancer [12]. National cohort data also report that EOCRC more commonly presents as an emergency, at a more advanced stage of diagnosis [12, 14, 16, 17], although younger patients tend to have better survival than older patients [18, 19]. It has been suggested that advanced‐stage disease at presentation in younger patients may be due to delay in diagnosis, but there is also evidence that this may be due to a higher prevalence of biologically ‘aggressive’ tumours [16].…”

Evaluation of Demographic and Clinical Presentation of Colorectal Carcinoma in Rajshahi Region

“…Instead, these patients were more likely to have presented to their primary care provider, in the year before diagnosis, with nonspecific symptoms. 24 Individuals having ABO blood group B were in peak regarding developing colorectal carcinoma according to this study. 63% colorectal carcinomas were presented with tumour size ≤ 4 cm in this study.…”