Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study.
BACKGROUND
Colorectal cancer is the third most common cancer worldwide and second most common in Europe. Despite screening, it is often diagnosed at an unfavourable stage.


OBJECTIVE
To identify and quantify features of non-metastatic colorectal cancer in primary care to enable earlier diagnosis by GPs.


METHODS
A case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden.


METHODS
A total of 542 patients diagnosed with non-metastatic colorectal cancer in 2011 and 2139 matched controls were selected from the Swedish Cancer Register (SCR) and a regional healthcare database respectively. All diagnostic codes (according to ICD-10) from primary care consultations registered the year before the date of cancer diagnosis (according to the SCR) were collected from the regional database. Odds ratios were calculated for variables independently associated with non-metastatic colorectal cancer using multivariable conditional logistic regressions. Positive predictive values (PPVs) of these variables were calculated, both individually and in combination with each other.


RESULTS
Five features were associated with colorectal cancer before diagnosis: bleeding, including rectal bleeding, melaena, and gastrointestinal bleeding (PPV 3.9%, 95% confidence interval [CI] = 2.3 to 6.3); anaemia (PPV 1.4%, 95% CI = 1.1 to 1.8); change in bowel habit (PPV 1.1%, 95% CI = 0.9 to 1.5; abdominal pain (PPV 0.9%, 95% CI = 0.7 to 1.1); and weight loss (PPV 1.0%, 95% CI = 0.3 to 3.0); all P-value <0.05. The combination of bleeding and change in bowel habit had a PPV of 13.7% (95% CI = 2.1 to 54.4); for bleeding combined with abdominal pain this was 12.2% (95% CI = 1.8 to 51.2). A risk assessment tool for non-metastatic colorectal cancer was designed.


CONCLUSIONS
Bleeding combined with either diarrhoea, constipation, change in bowel habit, or abdominal pain are the most powerful predictors of non-metastatic colorectal cancer and should result in prompt referral for colorectal investigation.
Department of Public Health and Community Medicine/Primary Health Care.
Marcela
M
Ewing
Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Peter
P
Naredi
Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Gothenburg, Sweden.
Chenyang
C
Zhang
Department of Public Health and Community Medicine/Primary Health Care.
Jörgen
J
Månsson
D015746:Abdominal Pain; D000328:Adult; D000740:Anemia; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality; D003248:Constipation; D016208:Databases, Factual; D003967:Diarrhea; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment / Q000458:organization & administration*; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D015431:Weight Loss
Sweden; colorectal cancer; diagnosis; general practice; primary health care