Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses

被引:16
作者
Renzi, Cristina [1 ,2 ]
Lyratzopoulos, Georgios [1 ]
Hamilton, Willie [3 ]
Rachet, Bernard [2 ]
机构
[1] UCL, Dept Behav Sci & Hlth, London, England
[2] London Sch Hyg & Trop Med, Canc Survival Grp, Dept Noncommunicable Dis Epidemiol, London, England
[3] Univ Exeter, Sch Med, Exeter, Devon, England
关键词
colon cancer; data-linkage; emergency diagnosis; primary care; symptoms; IRRITABLE-BOWEL-SYNDROME; COLORECTAL-CANCER; PRIMARY-CARE; GENERAL-PRACTICE; DIVERTICULAR-DISEASE; FECAL CALPROTECTIN; CONSULTATIONS; COHORT; ASSOCIATION; HEMOGLOBIN;
D O I
10.1111/ecc.13000
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objectives 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% vs. 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 2-5 years 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 vs. none (OR = 4.41; 95% CI 1.3-14.9). Conclusions 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.
引用
收藏
页数:13
相关论文
共 50 条
[1]   Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers [J].
Abel, G. A. ;
Shelton, J. ;
Johnson, S. ;
Elliss-Brookes, L. ;
Lyratzopoulos, G. .
BRITISH JOURNAL OF CANCER, 2015, 112 :S129-S136
[2]   Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data [J].
Abel, Gary A. ;
Mendonca, Silvia C. ;
McPhail, Sean ;
Zhou, Yin ;
Elliss-Brookes, Lucy ;
Lyratzopoulos, Georgios .
BRITISH JOURNAL OF GENERAL PRACTICE, 2017, 67 (659) :E377-E387
[3]  
BMA, 2016, SAF WORK GEN PRACT
[4]   The Incidence of Other Gastroenterological Disease following Diagnosis of Irritable Bowel Syndrome in the UK: A Cohort Study [J].
Canavan, Caroline ;
Card, Timothy ;
West, Joe .
PLOS ONE, 2014, 9 (09)
[5]   The Yield of Colonoscopy in Patients With Non-Constipated Irritable Bowel Syndrome: Results From a Prospective, Controlled US Trial [J].
Chey, William D. ;
Nojkov, Borko ;
Rubenstein, Joel H. ;
Dobhan, Richard R. ;
Greenson, Joel K. ;
Cash, Brooks D. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2010, 105 (04) :859-865
[6]   Sex Disparities in Diagnosis of Bladder Cancer After Initial Presentation With Hematuria A Nationwide Claims-Based Investigation [J].
Cohn, Joshua A. ;
Vekhter, Benjamin ;
Lyttle, Christopher ;
Steinberg, Gary D. ;
Large, Michael C. .
CANCER, 2014, 120 (04) :555-561
[7]   Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers: Analysis of Data from the UK Clinical Practice Research Datalink [J].
Din, Nafees U. ;
Ukoumunne, Obioha C. ;
Rubin, Greg ;
Hamilton, William ;
Carter, Ben ;
Stapley, Sal ;
Neal, Richard D. .
PLOS ONE, 2015, 10 (05)
[8]   Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study [J].
Doubeni, Chyke A. ;
Corley, Douglas A. ;
Quinn, Virginia P. ;
Jensen, Christopher D. ;
Zauber, Ann G. ;
Goodman, Michael ;
Johnson, Jill R. ;
Mehta, Shivan J. ;
Becerra, Tracy A. ;
Zhao, Wei K. ;
Schottinger, Joanne ;
Doria-Rose, V. Paul ;
Levin, Theodore R. ;
Weiss, Noel S. ;
Fletcher, Robert H. .
GUT, 2018, 67 (02) :291-U253
[9]   How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996-2006 [J].
Ellis, Libby ;
Coleman, Michel P. ;
Rachet, Bernard .
EUROPEAN JOURNAL OF CANCER, 2012, 48 (02) :270-278
[10]   Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets [J].
Elliss-Brookes, L. ;
McPhail, S. ;
Ives, A. ;
Greenslade, M. ;
Shelton, J. ;
Hiom, S. ;
Richards, M. .
BRITISH JOURNAL OF CANCER, 2012, 107 (08) :1220-1226