title: Systematic review of clinical features of suspected colorectal cancer in primary care.
abstract: OBJECTIVE
  To systematically review the diagnostic accuracy of clinical features associated with colorectal cancer (CRC) presenting in primary care.
  
  
  METHODS
  MEDLINE and EMBASE were searched for studies in primary care that provided information on clinical features predictive of CRC. Positive predictive values were used to guide the determination of clinical features associated with increased risk of CRC.
  
  
  METHODS
  Systematic reviews or primary studies that provided possible clinical features predictive of CRC were included.
  
  
  RESULTS
  Clinical features of patients presenting in primary care that are associated with increased risk of CRC, listed in descending order of association, included palpable rectal or abdominal mass; rectal bleeding combined with weight loss; iron deficiency anemia; rectal bleeding mixed with stool; rectal bleeding in the absence of perianal symptoms; rectal bleeding combined with change in bowel habits; dark rectal bleeding; rectal bleeding and diarrhea; and change in bowel habits. Being male and increasing age were also, in general, associated with increased risk of CRC.
  
  
  CONCLUSIONS
  Recognition of clinical features associated with increased risk of CRC by FPs might help with earlier identification and referral among patients presenting in primary care. This review might help inform providers and CRC diagnostic assessment programs about indications for assessment and further investigation.
authors.affiliation: Physician with the Sunnybrook Academic Family Health Team in Toronto, Ont, and is Regional Primary Care Cancer Lead for the Toronto Central Local Health Integration Network. ccopgi@mcmaster.ca.
authors.forename: M Elisabeth
authors.initials: ME
authors.lastname: Del Giudice
authors.affiliation: Health Research Methodologist in the Department of Oncology at McMaster University in Hamilton, Ont, and for Cancer Care Ontario's Program in Evidence-based Care. ccopgi@mcmaster.ca.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Vella
authors.affiliation: Regional Primary Care Lead at the Northeast Cancer Centre in Sudbury, Ont.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hey
authors.affiliation: Surgical oncologist at the Juravinski Cancer Centre in Hamilton.
authors.forename: Marko
authors.initials: M
authors.lastname: Simunovic
authors.affiliation: Surgeon at Thunder Bay Regional Health Sciences Centre in Ontario.
authors.forename: William
authors.initials: W
authors.lastname: Harris
authors.affiliation: Professor in the Department of Family Medicine at McMaster University and Past Provincial Primary Care Lead at Cancer Care Ontario.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*