title: Assessing the value of matrix metalloproteinase 9 (MMP9) in improving the appropriateness of referrals for colorectal cancer.
abstract: BACKGROUND
  A blood test may be an effective means of improving the appropriateness of referrals for symptomatic patients referred to specialist colorectal clinics. We evaluated the accuracy of a serum matrix metalloproteinase (MMP9) test in indicating colorectal cancer or its precursor conditions in a symptomatic population.
  
  
  METHODS
  Patients aged over 18, referred urgently or routinely to secondary care following primary care presentation with colorectal symptoms completed a questionnaire and provided a blood sample for serum MMP9 estimation. Univariate analysis and logistic regression modelling investigated the association between presenting symptoms, MMP9 measurements and the diagnostic outcome of patient investigations, in order to derive the combination of factors which best predicted a high risk of malignancy.
  
  
  RESULTS
  Data were analysed for 1002 patients. Forty-seven cases of neoplasia were identified. Age, male gender, absence of anal pain, diabetes, blood in stools, urgent referral, previous bowel polyps and previous bowel cancer were significantly associated with neoplasia. Matrix metalloproteinase 9 measurements were not found to be associated with significant colorectal pathology.
  
  
  CONCLUSIONS
  This study, despite robust sampling protocols, showed no clear association between MMP9 and colorectal neoplasia. Matrix metalloproteinase 9 therefore appears to have little value as a tool to aid referral decisions in the symptomatic population.
authors: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK.
authors: S
authors: S
authors: Damery
authors: L
authors: L
authors: Nichols
authors: R
authors: R
authors: Holder
authors: S T
authors: ST
authors: Ward
authors: S
authors: S
authors: Warmington
authors: S
authors: S
authors: Wilson
authors: M J
authors: MJ
authors: Wakelam
authors: J
authors: J
authors: James
authors: T
authors: T
authors: Ismail
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D012017:Referral and Consultation; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D020780:Matrix Metalloproteinase 9
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