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Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study.

Journal article
Authors Marcela Ewing
Peter Naredi
Chenyang Zhang
Jörgen Månsson
Published in The British journal of general practice : the journal of the Royal College of General Practitioners
Volume 66
Issue 653
Pages e880-e886
ISSN 1478-5242
Publication year 2016
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Medicine, School of Public Health and Community Medicine
Pages e880-e886
Language en
Subject categories Surgery


Colorectal cancer is the third most common cancer worldwide and second most common in Europe. Despite screening, it is often diagnosed at an unfavourable stage.To identify and quantify features of non-metastatic colorectal cancer in primary care to enable earlier diagnosis by GPs.A case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden.A total of 542 patients diagnosed with non-metastatic colorectal cancer in 2011 and 2139 matched controls were selected from the Swedish Cancer Register (SCR) and a regional healthcare database respectively. All diagnostic codes (according to ICD-10) from primary care consultations registered the year before the date of cancer diagnosis (according to the SCR) were collected from the regional database. Odds ratios were calculated for variables independently associated with non-metastatic colorectal cancer using multivariable conditional logistic regressions. Positive predictive values (PPVs) of these variables were calculated, both individually and in combination with each other.Five features were associated with colorectal cancer before diagnosis: bleeding, including rectal bleeding, melaena, and gastrointestinal bleeding (PPV 3.9%, 95% confidence interval [CI] = 2.3 to 6.3); anaemia (PPV 1.4%, 95% CI = 1.1 to 1.8); change in bowel habit (PPV 1.1%, 95% CI = 0.9 to 1.5; abdominal pain (PPV 0.9%, 95% CI = 0.7 to 1.1); and weight loss (PPV 1.0%, 95% CI = 0.3 to 3.0); all P-value <0.05. The combination of bleeding and change in bowel habit had a PPV of 13.7% (95% CI = 2.1 to 54.4); for bleeding combined with abdominal pain this was 12.2% (95% CI = 1.8 to 51.2). A risk assessment tool for non-metastatic colorectal cancer was designed.Bleeding combined with either diarrhoea, constipation, change in bowel habit, or abdominal pain are the most powerful predictors of non-metastatic colorectal cancer and should result in prompt referral for colorectal investigation.

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