Rectal bleeding and colorectal cancer in general practice: diagnostic study

Wauters, H. A.; Casteren, Viviane Van; Buntinx, Frank

doi:10.1136/bmj.321.7267.998

Cited by 54 publications

(44 citation statements)

References 4 publications

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“…Eight studies met our inclusion criteria and were included in the final analysis (Figure 1; Mant et al, 1989;Fijten et al, 1995;Metcalf et al, 1996;Norrelund and Norrelund, 1996;Wauters et al, 2000;Ellis and Thompson, 2005;Heintze et al, 2005;du Toit et al, 2006).…”

Section: Resultsmentioning

confidence: 99%

“…The eight studies included 2323 patients and were carried out in primary care settings in England (Metcalf et al, 1996;Ellis and Thompson, 2005;du Toit et al, 2006), the Netherlands (Fijten et al, 1995), Germany (Heintze et al, 2005), Denmark (Norrelund and Norrelund, 1996), Belgium (Wauters et al, 2000) and Australia (Mant et al, 1989). The mean weighted prior probability of colorectal cancer was 7.0% (range: 3.3 -15.4%, median: 8.1%).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Only two studies describe how many patients underwent a particular reference standard investigation (Mant et al, 1989;Metcalf et al, 1996). Follow-up was adequately described in three of the eight studies and ranged from, at least, 12 to 32 months (Fijten et al, 1995;Norrelund and Norrelund, 1996;Wauters et al, 2000). Follow-up was carried out by either sending recall letters to the general practitioner to obtain the number of all the new cases of cancer (Wauters et al, 2000), microscopic verification of colorectal cancer or an yearly letter to the general practitioner (Norrelund and Norrelund, 1996), or by checking medical records and information provided by the general practitioner (Fijten et al, 1995).…”

Section: Definition Of the Reference Standard Test And Follow Upmentioning

confidence: 99%

“…This might be due to whether or not rectal bleeding was the principal reason for consultation and also the duration of rectal bleeding. Three included studies report rectal bleeding as the primary complaint in 15%, 51% and 100% of patients, respectively, (Fijten et al, 1995;Metcalf et al, 1996;Wauters et al, 2000), and in terms of duration two studies excluded patients with rectal bleeding longer than six and twelve months, respectively (Mant et al, 1989;Metcalf et al, 1996).…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

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Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

et al. 2009

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BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009 and PsychINFO (1970 to May 2009 were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3 -15.4%, median: 8.1%). Age X60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00 -3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03 -3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54 -3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30 -10.35), specificity 0.95 (95% CI: 0.93 -0.96), but still only generates a posttest probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Definition Of the Reference Standard Test And Follow Upmentioning

confidence: 99%

Section: Limitations Of the Present Studymentioning

confidence: 99%

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Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

et al. 2009

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“…40 Several recent studies have examined rectal bleeding. [16][17]38,[41][42][43][44][45] No study has reported a risk for rectal bleeding below 2%, except in those under 60 years of age. 17 Current UK referral guidance requires 6 weeks of bleeding or bleeding accompanied by diarrhoea for an urgent referral.…”

Section: Colorectal Cancermentioning

confidence: 99%

Cancer diagnosis in primary care

2010

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Around a quarter of those in the developed world die of cancer. Most cancers present to primary care with symptoms, even when there is a screening test for the particular cancer. However, the symptoms of cancer are also symptoms of benign disease, and the GP has to judge whether cancer is a possible explanation. Very little research examined this process until relatively recently. This review paper examines the process of primary care diagnosis, especially the selection of patients for rapid investigation. It concentrates on the four commonest UK cancers: breast, lung, colon, and prostate as these have been the subject of most recent studies.

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