eprintid: 10065198
rev_number: 22
eprint_status: archive
userid: 608
dir: disk0/10/06/51/98
datestamp: 2019-01-08 08:38:09
lastmod: 2021-09-24 21:56:12
status_changed: 2019-01-08 08:38:09
type: article
metadata_visibility: show
creators_name: Cross, AJ
creators_name: Wooldrage, K
creators_name: Robbins, EC
creators_name: Pack, K
creators_name: Brown, JP
creators_name: Hamilton, W
creators_name: Thompson, MR
creators_name: Flashman, KG
creators_name: Halligan, S
creators_name: Thomas-Gibson, S
creators_name: Vance, M
creators_name: Saunders, BP
creators_name: Atkin, W
title: Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study
ispublished: inpress
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: FI6
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abstract: BACKGROUND: Patients with suspected colorectal cancer (CRC) usually undergo colonoscopy. Flexible sigmoidoscopy (FS) may be preferred if proximal cancer risk is low. We investigated which patients could undergo FS alone. METHODS: Cohort study of 7375 patients (≥55 years) referred with suspected CRC to 21 English hospitals (2004-2007), followed using hospital records and cancer registries. We calculated yields and number of needed whole-colon examinations (NNE) to diagnose one cancer by symptoms/signs and subsite. We considered narrow (haemoglobin <11 g/dL men; <10 g/dL women) and broad (<13 g/dL men; <12 g/dL women) anaemia definitions and iron-deficiency anaemia (IDA). RESULTS: One hundred and twenty-seven proximal and 429 distal CRCs were diagnosed. A broad anaemia definition identified 80% of proximal cancers; a narrow definition with IDA identified 39%. In patients with broad definition anaemia and/or abdominal mass, proximal cancer yield and NNE were 4.8% (97/2022) and 21. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency (41% of cohort), proximal cancer yield and NNE were 0.4% (13/3031) and 234. CONCLUSION: Most proximal cancers are accompanied by broad definition anaemia. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice.
date: 2019
date_type: published
official_url: https://doi.org/10.1038/s41416-018-0335-z
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
article_type_text: Journal Article
verified: verified_manual
elements_id: 1616830
doi: 10.1038/s41416-018-0335-z
pii: 10.1038/s41416-018-0335-z
lyricists_name: Halligan, Michael Stephen
lyricists_id: HALLI02
actors_name: Bracey, Alan
actors_id: ABBRA90
actors_role: owner
full_text_status: public
publication: British Journal of Cancer
event_location: England
issn: 1532-1827
citation:        Cross, AJ;    Wooldrage, K;    Robbins, EC;    Pack, K;    Brown, JP;    Hamilton, W;    Thompson, MR;                         ... Atkin, W; + view all <#>        Cross, AJ;  Wooldrage, K;  Robbins, EC;  Pack, K;  Brown, JP;  Hamilton, W;  Thompson, MR;  Flashman, KG;  Halligan, S;  Thomas-Gibson, S;  Vance, M;  Saunders, BP;  Atkin, W;   - view fewer <#>    (2019)    Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study.                   British Journal of Cancer        10.1038/s41416-018-0335-z <https://doi.org/10.1038/s41416-018-0335-z>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10065198/1/s41416-018-0335-z.pdf