Recognising Colorectal Cancer in Primary Care

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. Primary care professionals can play an important role in both prevention and early detection of CRC. Most CRCs are attributed to modifiable lifestyle factors, which can be addressed within primary care, and promotion of population-based screening programmes can aid early cancer detection in asymptomatic patients. Primary care professionals have a vital role in clinically assessing patients presenting with symptoms that may indicate cancer, as most patients with CRC first present with symptoms. These assessments are often challenging—many of the symptoms of CRC are non-specific and commonly occur in patients presenting with non-malignant disease. The range of options for investigating symptomatic patients in primary care is rapidly growing. Simple tests, such as faecal immunochemical testing (FIT), are now being used to guide decisions around referral for more invasive tests, such as colonoscopy, while direct access to specialist investigations is also becoming more common. Clinical decision support tools (CDSTs) which calculate cancer risk based on symptomatology, patient characteristics and test results can provide an additional resource to guide decisions on further investigation. This article explores the challenges of CRC prevention and detection from the primary care perspective, discusses current evidence-based approaches for CRC detection used in primary care (with examples from UK guidelines), and highlights emerging research which may likely alter practice in the future.

Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems

“…Most patients with CRC have symptoms at presentation, with some studies reporting nearly 90 % of patients as symptomatic at diagnosis [ 12 , 15 ]. Amongst the symptoms at presentation, blood per rectum, changes in bowel habits (diarrhea or constipation), abdominal pain, weight loss, and anemia have been reported as the most common [ 16 , 17 ].…”

“…These factors closely align with the patient group demographics within safety-net hospitals, predominantly consisting of ethnic minorities status and underserved communities who frequently lack health care insurance, resulting in poor access to regular medical care [ 10 , 11 ]. Given low screening rates, the majority of patients from these groups are diagnosed with CRC after presenting with symptoms [ 12 ]. PCPs are crucial in recognizing these symptoms and directing care for appropriate diagnosis.…”

Colorectal cancer risk stratification using a polygenic risk score in symptomatic patients presenting to primary care – a UK Biobank retrospective cohort study

“…(24)(25)(26)(27) CRC symptoms are olen non-specific for cancer -e.g., abdominal pain, weight loss -and can make it challenging for clinicians to decide which pa.ents may benefit from a diagnos.c referral. (28) It has previously been shown that a PRS can stra.fy symptoma.c pa.ents according to risk of developing prostate cancer within a two year window. (29) Therefore, in this study, an integrated risk model (IRM) was developed which combines informa.on about par.cipant symptoms with a PRS and other risk factors, to predict which of a cohort of symptoma.c pa.ents are most at risk of CRC in the next two years.…”

Assessing Ethnic Inequalities in Diagnostic Interval of Common Cancers: A Population-Based UK Cohort Study

“…We are uncertain why DI was longer in Asian and Black patients with colorectal and oesophagogastric cancer, and in Black patients with myeloma. Until the recent introduction of faecal immunochemical testing to primary care, GPs had to refer all patients with clinical features of suspected colorectal cancer to secondary care for diagnostic investigations [46][47][48]. The same process applies to myeloma and oesophagogastric cancer.…”