ConclusionBleeding combined with either diarrhoea, constipation, change in bowel habit, or abdominal pain are the most powerful predictors of nonmetastatic colorectal cancer and should result in prompt referral for colorectal investigation. In order to increase survival rates for people with colorectal cancer, the most important factor is to be able to identify patients with a potentially curable disease. Sweden has high survival rates in colorectal cancer, despite not having a national screening programme. In contrast with both the UK and Denmark, however, primary care practitioners in Sweden do not have a role as 'gatekeepers'. These different conditions mean there is a need for risk assessment tools that can be used to detect colorectal cancer early in different primary care settings. As Sweden possesses unique total population-based databases, a casecontrol study was conducted using regional healthcare databases and a national cancer register. This study aimed to:• identify and quantify the clinical features of non-metastatic colorectal cancer in primary care, both as single symptoms and in combinations; and• develop a risk assessment tool for nonmetastatic colorectal cancer for use in primary care. METHOD Study designA total population-based, case-control study using the Swedish Cancer Register and a regional healthcare database in Region Västra Götaland (RVG), Sweden, was designed. This region, which has 1.6 million inhabitants (17% of the Swedish population), is situated in the south-west of the country and includes both rural and urban areas. The Swedish Cancer Register, which was established in 1958, is one of the oldest disease registers in Sweden and has high validity. 24 All physicians, including pathologists, in Sweden are obliged by law to report all incident cases of cancer from both living and dead patients to the Swedish Cancer Register. 25 Each patient has a unique personal identity number, which all Swedish residents acquire either at birth or when they immigrate to Sweden.The regional healthcare database was established in RVG in 2000. It covers all hospitals, specialised outpatient care, and all private and public primary healthcare centres. The database includes place of residence, age, sex, healthcare contacts, and diagnostic codes for diagnoses and surgical procedures. 26Physicians are obliged to enter codes for a patient's current disease(s) or symptoms into the patient's medical records at each consultation. The reimbursement system for primary care providers is partly based on the disease burden of the patients, which is identified by diagnostic codes reported to this database. Study populationAll patients with colorectal cancer diagnosed in 2011 in RVG were identified from the Swedish Cancer Register. Patients and matched controls were investigated for primary care diagnostic profiles. Inclusion criteria were:• diagnosed in RVG with colorectal cancer;• alive at the time of the cancer diagnosis;• aged ≥18 years; and• visited the GP during the year before cancer diagnosis.Individuals ...
ObjectiveTo identify early diagnostic profiles such as diagnostic codes and consultation patterns of cancer patients in primary care one year prior to cancer diagnosis.DesignTotal population-based case–control study.Setting and subjects4562 cancer patients and 17,979 controls matched by age, sex, and primary care unit. Data were collected from the Swedish Cancer Register and the Regional Healthcare Database.MethodWe identified cancer patients in the Västra Götaland Region of Sweden diagnosed in 2011 with prostate, breast, colorectal, lung, gynaecological, and skin cancers including malignant melanoma. We studied the symptoms and diagnoses identified by diagnostic codes during a diagnostic interval of 12 months before the cancer diagnosis.Main outcome measuresConsultation frequency, symptom density by cancer type, prevalence and odds ratios (OR) for the diagnostic codes in the cancer population as a whole.ResultsThe diagnostic codes with the highest OR were unspecified lump in breast, neoplasm of uncertain behaviour, and abnormal serum enzyme levels. The codes with the highest prevalence were hyperplasia of prostate, other skin changes and abdominal and pelvic pain. The frequency of diagnostic codes and consultations in primary care rose in tandem 50 days before diagnosis for breast and gynaecological cancer, 60 days for malignant melanoma and skin cancer, 80 days for prostate cancer and 100 days for colorectal and lung cancer.ConclusionEighty-seven percent of patients with the most common cancers consulted a general practitioner (GP) a year before their diagnosis. An increase in consultation frequency and presentation of any symptom should raise the GP’s suspicion of cancer. Key pointsKnowledge about the prevalence of early symptoms and other clinical signs in cancer patients in primary care remains insufficient.• Eighty-seven percent of the patients with the seven most common cancers consulted a general practitioner 12 months prior to cancer diagnosis.• Both the frequency of consultation and the number of symptoms and diseases expressed in diagnostic codes rose in tandem 50–100 days before the cancer diagnosis.• Unless it is caused by a previously known disease, an increased consultation rate for any symptom should result in a swift investigation or referral from primary care to confirm or exclude cancer.
Yanking the chain: A general method for the preparation of colloidal analogues of polymer chains was developed (see picture). The flexibility of these chains can be tuned by applying electric fields in combination with their subjection to simple linkage‐forming procedures.
Background Early detection of colorectal cancer (CRC) is crucial for survival. Primary care, the first point of contact in most cases, needs supportive risk assessment tools. We aimed to replicate the Swedish Colorectal Cancer Risk Assessment Tool (SCCRAT) for non-metastatic CRC in primary care and examine if risk factor patterns depend on sex and age. Methods 2,920 adults diagnosed with non-metastatic CRC during the years 2015–2019 after having visited a general practitioner the year before the diagnosis were selected from the Swedish Cancer Register and matched with 11,628 controls, using the same inclusion criteria except for the CRC diagnosis. Diagnostic codes from primary care consultations were collected from a regional health care database. Positive predictive values (PPVs) were estimated for the same 5 symptoms and combinations thereof as in the baseline study. Results The results for patients aged ≥50 years old in the present study were consistent with the results of the SCCRAT study. All symptoms and combinations thereof with a PPV >5% in the present study had a PPV >5% in the baseline study. The combination of bleeding with abdominal pain (PPV 9.9%) and bleeding with change in bowel habit (PPV 7.8%) were the highest observed PPVs in both studies. Similar risk patterns were seen for all ages and when men and women were studied separately. Conclusion This external validation of the SCCRAT for non-metastatic CRC in primary care replicated the baseline study successfully and identified patients at high risk for CRC.
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