The diagnostic value of a change in bowel habit for colorectal cancer within different age groups

Abstract

Background Change in bowel habit as a sole alarm symptom for colorectal cancer is disputed. Objective We investigated the diagnostic value of change in bowel habit for colorectal cancer, particularly as a single symptom and within different age groups. Methods This retrospective cohort study examined colorectal cancer fast track referrals and outcomes across four Swedish hospitals (April 2016–May 2017). Entry criteria constituted one or more of three alarm features: anaemia, visible rectal bleeding, or change in bowel habit for more than 4 weeks in patients over 40 years of age. Patients were grouped as having only change in bowel habit, change in bowel habit plus anaemia/bleeding or anaemia/bleeding only. Results Of 628 patients, 22% were diagnosed with colorectal cancer. There were no cases of colorectal cancer in the only change in bowel habit group under 55 years, while this was 6% for 55–64 years, 8% for 65–74 years and 14% for 75 years and older. Among subjects under 55 years, 2% with anaemia/bleeding had colorectal cancer, this increased to 34% for 55 years and older ( P < 0.0001). Change in bowel habit plus anaemia/bleeding gave a colorectal cancer prevalence of 16% in under 55 years and increased to 30% for 55 years and older ( P = 0.07). Conclusion Change in bowel habit as the only alarm feature has a low diagnostic yield for colorectal cancer in patients under 55 years.

Clinical value of alarm features for colorectal cancer: a meta-analysis

“…Anemia was assessed by 18 studies [17,18,[31][32][33][34]36,38,[40][41][42]46,47,49,53,[56][57][58] including 31157 patients, with a pooled prevalence of CRC of 6.2% (95%CI 3.8-8.6%). Anemia had 24.6% (95%CI 17.4-33.6%) sensitivity and 90.4% (95%CI 86.6-93.2%) specificity for CRC (see Figure 1B and Figure 2B).…”

“…Change in bowel habit was assessed by 21 studies [17,[31][32][33]35,36,38,[40][41][42][43][44]46,48,49,51,[53][54][55][56][57] including 29829 patients, with a pooled prevalence of CRC of 8.3% (95%CI 4.6-11.9%). Change in bowel habit had 26.3% (95%CI 14.8-42.4%) sensitivity and 78.6% (95%CI 65.7-87.6%) specificity for CRC (see Figure 1C and Figure 2C).…”

Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study

“…We found that patients of Asian, Black, and Mixed ethnic groups were less likely than White patients to have a record of changes in bowel habits, although the Asian group were more likely to have iron-deficiency anaemia. Both features have low PPVs for cancer in the general population, except when accompanied by other features [ 40 ]. In this study, over half of Asian and Black patients with changes in bowel habits and two-thirds of Asians with iron-deficiency anaemia had these recorded as isolated features, which may explain the recent report of longer times to diagnosis in these groups compared with the White group [ 11 ].…”

What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer?

“…In addition to the impact caused by the disease, rectal cancer significantly affects both the well-being and chances of survival for individuals affected by it. Rectal bleeding, altered bladder habits, stomach discomfort, and unintentional weight loss are only a few symptoms that may seriously affect everyday life and general wellbeing [ 4 ]. This further intensifies the challenging experience for individuals undergoing cancer treatment.…”