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NICE misses patients at colon Ca risk

Patients with a risk of colorectal cancer justifying investigation are missing out on referral under current guidelines, a new analysis reveals.

Researchers criticised NICE for recommending men and non-menstruating women with iron deficiency anaemia were only referred where haemoglobin levels were below 11g/dl and 10g/dl respectively.

They warned some iron-deficient patients with near-normal haemoglobin levels would not be referred, despite a high risk of cancer.

The risk of having a colorectal cancer diagnosed in the year after investigation for anaemia ranged from 7.2% to 7.6% in men over 60 with haemoglobin below 10g/dl and 2.7% to 5% for women of the same age and degree of anaemia.

But once patients had evidence of iron-deficiency the risk was much higher – as high as 12% for men with haemoglobin values up to 13g/dl and 3.5% in women.

Dr William Hamilton, a primary care researcher at the University of Bristol and a GP in Exeter, told the conference: 'If men have iron deficiency they are at greater risk, full stop.

One man in six under NICE guidance will not be referred. In women, the figure is about half that.'

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