What is it about?
Efficient as well as effective management of the large numbers of people presenting with symptoms suggestive of bowel cancer is a major challenge. Current management is resulting in over referral of patients to hospital resulting in over investigation by whole colonic imaging. This study shows for the first time that over 90% of bowel cancer patients present with specific symptoms and signs which could improve selection of the right people at the right time for the right test.
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Why is it important?
Currently the assumpton that most bowel cancers present with non-specific symptoms has resulted in poorly focussed public awareness campaign and referral guidelines. This is resulting in inappropriate use of scarce healthcare resources. These data suggest that it is possible to better select patients at higher risk of having bowel cancer for prompt diagnosis as well as those at lower risk with transient symptoms from benign conditions to avoid over investigation.
Perspectives
This study over 22 years has required the co-operation of large numbers of colleagues including outpatient nursing staff to collect the data. It would have been difficult to achieve without the introduction of flexible sigmoidoscpy into outpatient colorectal clinics, intially funded by the Leagues of Friends in three Portsmouth Hospitals with the encoragment of a local primary care doctor. The analysis of the information collected on 29005 patients could not have been achieved without a junior colleague's expertise in IT in 1986 and a superb data manager. This study is another mostly hidden benefit of the collaborative work that can be done in the NHS on the basis of money donated by a relatively small bowel cancer charityand a local business. The authors are very aware of the debt of gratitude they owe to all our colleages that have helped over the years to complete this study.
Michael Thompson
Portsmouth Hospitals NHS Trust
Read the Original
This page is a summary of: Clinical assessment to determine the risk of bowel cancer using Symptoms, Age, Mass and Iron deficiency anaemia (SAMI), BJS, June 2017, Wiley,
DOI: 10.1002/bjs.10573.
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