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.
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.
Authors: Dayna S Early; Tamir Ben-Menachem; G Anton Decker; John A Evans; Robert D Fanelli; Deborah A Fisher; Norio Fukami; Joo Ha Hwang; Rajeev Jain; Terry L Jue; Khalid M Khan; Phyllis M Malpas; John T Maple; Ravi S Sharaf; Jason A Dominitz; Brooks D Cash Journal: Gastrointest Endosc Date: 2012-06 Impact factor: 9.427
Authors: M Elisabeth Del Giudice; Emily T Vella; Amanda Hey; Marko Simunovic; William Harris; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: Sally A Stapley; Greg P Rubin; Deborah Alsina; Elizabeth A Shephard; Matthew D Rutter; William T Hamilton Journal: Br J Gen Pract Date: 2017-03-27 Impact factor: 5.386
Authors: William Hamilton; Robert Lancashire; Debbie Sharp; Tim J Peters; Kk Cheng; Tom Marshall Journal: BMC Med Date: 2009-04-17 Impact factor: 8.775