Renzi, C;
Lyratzopoulos, G;
Hamilton, W;
Rachet, B;
(2019)
Opportunities for reducing emergency diagnoses of colon cancer in women and men: a data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses.
European Journal of Cancer Care
, 28
(2)
, Article e13000. 10.1111/ecc.13000.
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Abstract
OBJECTIVEW: To identify opportunities for reducing emergency colon cancer diagnoses we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP). METHODS: Cohort of 5,745 colon cancers diagnosed in England 2005-2010, with individually-linked cancer registry and primary care data for the 5-year pre-diagnostic period. RESULTS: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p=0.002) had alarm symptoms (anaemia/rectal bleeding/ change in bowel habit) 2-12 months pre-diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% versus 6% among women and men (p=0.002). EP was more likely in women (OR=1.20; 95%CI 1.1-1.4), independently of socio-demographic factors and symptoms. Benign diagnoses in the pre-diagnostic year (OR=2.01; 95%CI 1.2-3.3) and anaemia 2-5years pre-diagnosis (OR=1.91; 95%CI 1.2-3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40-59 with a recent benign diagnosis versus none (OR=4.41; 95%CI 1.3-14.9). CONCLUSION: Women have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40-59 years with new onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One-fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis.
| Type: | Article |
|---|---|
| Title: | Opportunities for reducing emergency diagnoses of colon cancer in women and men: a data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/ecc.13000 |
| Publisher version: | https://doi.org/10.1111/ecc.13000 |
| Language: | English |
| Additional information: | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/ |
| Keywords: | emergency diagnosis; colon cancer; primary care; data-linkage; symptoms |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10065886 |
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