Missed Opportunities for the Diagnosis of Colorectal Cancer.
OBJECTIVE
To examine patient and medical characteristics which predict a missed diagnostic opportunity (MDO) for colorectal cancer (CRC).


METHODS
The sample consisted of 252 patients diagnosed with Stages 1-4 CRC who were diagnosed in the prior six months, had experienced symptoms prior to diagnosis, and were not diagnosed through routine screening. Systematic review of all medical records prior to patients' diagnosis was conducted. An MDO was defined as a clinical encounter where, even in the presence of presumptive CRC symptoms, the CRC diagnostic process is not started.


RESULTS
92 patients (36.5%) experienced an MDO. Almost 80% of alternate diagnoses were other GI-GU diseases, including hemorrhoids and diverticulitis. Stomach pain, anemia, and constipation were the most common symptoms experienced by the MDO group. These symptoms, and weight loss and vomiting, were more likely to be noted in the charts of the MDO patients (P < 0.04). Independent risk factors for MDO included age (<50) [OR = 2.29 (1.14-4.60), P = 0.02] and female sex [OR = 2.19 (1.16-4.16), P = 0.03]. Each additional physician seen, more than doubled the MDO risk [OR = 2.05 (1.53-2.74), P < 0.001].


CONCLUSIONS
Females, younger patients, and those consulting more physicians were all more likely to experience an MDO. Continued increased training of physicians to enhance knowledge of who is vulnerable to CRC is needed in addition to an increased focus to adherence to screening recommendations.
College of Public Health, Temple University, Philadelphia, PA 19122, USA ; Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA 23284, USA.
Laura A
LA
Siminoff
Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA 23284, USA ; Department of Methodology and Experimental Psychology, University of Deusto, Bilbao, 48007 Biscay, Spain.
Heather L
HL
Rogers
Department of Family Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
Sonja
S
Harris-Haywood
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors