Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study

We recognise the limitations of our study and appreciate the
need not to overwhelm endoscopic/diagnostic services or investigate patients
needlessly. However our study is one of a number of studies in primary care
that have shown a significant association of new onset rectal bleeding with
colorectal carcinoma (see table).

† % with CRC and rectal bleeding  5.2% for patients > 60years
age (no numbers given).

As yet there has been little discussion about the level of
risk that necessitates investigation, either urgently or non
urgently. Most of the studies above appear to suggest that a patient with any
rectal bleeding over the age of 45-50 years who presents in primary care has more
than a 5% chance of having colorectal carcinoma. We consider that this level of
risk warrants investigation.

Reference List

   1.   Goulston
K,.Dent O. How important is rectal bleeding in the
diagnosis of bowel cancer or polyps? The
Lancet 1986;261-5.

   2.   Fijten
G, Starmans R, et al. Predictive value of signs and symptoms for colorectal
cancer in patients with rectal bleeding in general practice. Family Practice 1995;12:279-87.

   3.   Metcalf
J et al. Incidence and causes of rectal bleeding in general practice as
detected by colonoscopy. British Journal
of General Practice 1996;46:161-4.

   4.   Norrelund
N. et al Colorectal cancer and polyps in patients aged 40 years and over who
consult a GP with rectal bleeding. Family
Practice 2006;13:160-5.

   5.   Wauters
H, Van Casteren V, Buntinx F. Rectal bleeding and colorectal cancer in general
practice: diagnostic study. BMJ 2000;321:998-9.

   6.   Ellis
B,.Thompson M. Factors identifying higher risk rectal
bleeding in general practice. British
Journal of General Practice 2005;55:949-55.

   7.   du Toit J, Hamilton W, Barraclough K. Risk in
primary care of colorectal cancer from new onset rectal bleeding: 10 year
prospective study. BMJ 2006;333:69-70.