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New risk tool helps GPs identify bowel cancer in under-50s, finds study

GPs can be helped to prioritise patients for colonoscopy by using a new bowel cancer risk tool, a study has found.

The new tool, developed by researchers at the universities of Exeter, Durham and North Tees, assigns a risk level to patients based on their symptoms and blood test results. The risks were calculated by assessing the frequency of various symptoms in patients aged under 50 with irritable bowel disease or colorectal cancer.

The tool recommends urgent referral for colonoscopy or specialist assessment for those with a risk greater than 3% and faecal calprotectin testing to rule out IBD in those with a risk of between one and 3%.

For colorectal cancer only, the tool assigns the highest risk level (17%) to rectal bleeding associated with rectal mass, followed by rectal bleeding with low haemoglobin (13%) and low mean red cell volume (8%).

For either colorectal cancer or IBD, rectal bleeding with abdominal pain and change in bowel habit warrant faecal calprotectin testing, with risk levels of 1.5% and 2% respectively.

‘For those whose diagnosis is not immediately apparent, the CRC/IBD risk assessment tool guides subsequent action… This strategy should increase the proportion of younger patients with inflammatory bowel disease or colorectal cancer to be diagnosed without delay,’ the report said.

Willie Hamilton, professor of primary care diagnostics at the University of Exeter Medical School, who led the research said: ‘The risk assessment tool should be used as a reminder to GPs to consider the likelihood of an individual patient having a serious bowel condition given the symptom or combination of symptoms they present with.

‘The tool does not replace clinical judgement but provides more information to base a referral decision.’

Br J Gen Pr 2017; available online 27 March


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