Symptom-based approach to colorectal cancer: survey of primary care physicians in Italy.
BACKGROUND
Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms.


OBJECTIVE
To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer.


METHODS
A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema.


RESULTS
Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P = ns). Cancer was found in 14.6% of patients. Age > 50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively).


CONCLUSIONS
The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged > 50 years with iron deficiency anaemia.
Panzuto
F
F
Department of Digestive and Liver Disease, II School of Medicine, Sant' Andrea Hospital, 'La Sapienza' University, Rome, Italy.
Chiriatti
A
A
Bevilacqua
S
S
Giovannetti
P
P
Russo
G
G
Impinna
S
S
Pistilli
F
F
Capurso
G
G
Annibale
B
B
Delle Fave
G
G
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D003287:Contrast Media; D003625:Data Collection; D003937:Diagnosis, Differential; D004733:Enema; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors
D003287:Contrast Media; D001466:Barium Sulfate