title: Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis.
abstract: Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n = 19,209) and matched references (n = 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV = 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms.
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Denmark.
authors.forename: Pernille Libach
authors.initials: PL
authors.lastname: Hansen
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Denmark.|Section of General Practice, Department of Public Health, Aarhus University, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hjertholm
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012017:Referral and Consultation; D012307:Risk Factors
keywords: colorectal neoplasms; diagnosis; early diagnosis; general practice; primary health care