Colorectal cancer and polyps in patients aged 40 years and over who consult a GP with rectal bleeding

Nørrelund, N; Nørrelund, Helene

doi:10.1093/fampra/13.2.160

Cited by 40 publications

(57 citation statements)

References 7 publications

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“…Some studies included only patients with a first rectal bleed. 12,[17][18][19] All data on rectal bleeding were grouped together. Sufficient data to calculate PPVs for rectal bleeding were available in 13 papers with 18 634 participants.…”

Section: Rectal Bleedingmentioning

confidence: 99%

“…Sufficient data to calculate PPVs for rectal bleeding were available in 13 papers with 18 634 participants. 11,12,14,[17][18][19][20][21][22][23][24][25][26] This is displayed as a Forest plot ( Figure 1A). The PPV ranged from 2.2% 18 to 15.8%.…”

Section: Rectal Bleedingmentioning

confidence: 99%

“…Six studies from five papers 20,[23][24][25][26] reported this symptom pair, 19,[21][22][23][24] with a total of 1466 evaluated participants. The pooled sensitivity was low, with no inconsistency between studies.…”

Section: Rectal Bleedingmentioning

confidence: 99%

“…Six studies from five papers reported these symptoms, with a total of 1468 evaluated participants. 19,[21][22][23][24] The pooled sensitivity of these symptoms was low but the specificity was stronger. The pooled PLR of 1.88 (95% CI = 1.25 to 2.83) and NLR of 0.93 (95% CI = 0.85 to 1.02) suggest that weight loss in addition to rectal bleeding increases the risk of an underlying cancer.…”

Section: Rectal Bleedingmentioning

confidence: 99%

See 3 more Smart Citations

The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review

Astin¹,

Griffin²,

Neal³

et al. 2011

Br J Gen Pract

221

179

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BackgroundOver 37 000 new colorectal cancers are diagnosed in the UK each year. Most present symptomatically to primary care. AimTo conduct a systematic review of the diagnostic value of symptoms associated with colorectal cancer. DesignSystematic review. MethodMEDLINE, Embase, Cochrane Library, and CINAHL were searched to February 2010, for diagnostic studies of symptomatic adult patients in primary care. Studies of asymptomatic patients, screening, referred populations, or patients with colorectal cancer recurrences, or with fewer than 100 participants were excluded. The target condition was colorectal cancer. Data were extracted to estimate the diagnostic performance of each symptom or pair of symptoms. Data were pooled in a meta-analysis. The quality of studies was assessed with the QUADAS tool. ResultsTwenty-three studies were included. Positive predictive values (PPVs) for rectal bleeding from 13 papers ranged from 2.2% to 16%, with a pooled estimate of 8.1% (95% confidence interval [CI] = 6.0% to 11%) in those aged ≥50 years. Pooled PPV estimates for other symptoms were: abdominal pain (three studies) 3.3% (95% CI = 0.7% to 16%); and anaemia (four studies) 9.7% (95% CI = 3.5% to 27%). For rectal bleeding accompanied by weight loss or change in bowel habit, pooled positive likelihood ratios (PLRs) were 1.9 (95% CI = 1.3 to 2.8) and 1.8 (95% CI = 1.3 to 2.5) respectively, suggesting higher risk when both symptoms were present. Conversely, the PLR was one or less for abdominal pain, diarrhoea, or constipation accompanying rectal bleeding. ConclusionThe findings suggest that investigation of rectal bleeding or anaemia in primary care patients is warranted, irrespective of whether other symptoms are present. The risks from other single symptoms are lower, though multiple symptoms also warrant investigation.

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Section: Rectal Bleedingmentioning

confidence: 99%

Section: Rectal Bleedingmentioning

confidence: 99%

Section: Rectal Bleedingmentioning

confidence: 99%

Section: Rectal Bleedingmentioning

confidence: 99%

See 2 more Smart Citations

The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review

Astin¹,

Griffin²,

Neal³

et al. 2011

Br J Gen Pract

221

179

View full text Add to dashboard Cite

show abstract

“…One in five patients reporting rectal bleeding was not investigated Á/ one possible explanation could be that a diagnosis was established by clinical examination (haemorrhoids) or that the recorded rectal bleeding (and a diagnosis) had been present earlier. In a Danish prospective study on rectal bleeding, Norrelund (16) found new onset of rectal bleeding or changes in bleeding pattern related to colorectal cancer, whereas this could not be shown in patients with a known tendency for rectal bleeding and with no change in the bleeding pattern. Unintended weight loss was left uninvestigated in 27% of the patients.…”

Section: Discussionmentioning

confidence: 91%