Colorectal cancer and rectal bleeding in primary care: Urban or rural myth?

doi:10.1136/bmj.333.7560.201-c

BMJ 2006;333:201-202 (22 July), doi:10.1136/bmj.333.7560.201-c

Letter

Colorectal cancer and rectal bleeding in primary care

Urban or rural myth?

The first 150 words of the full text of this article appear below.

EDITOR—Du Toit et al's finding of a one in 10 chance ofpatients over age 45 presenting with rectal bleeding and subsequentlybeing diagnosed with colorectal cancer is comparable to otherrecent studies,^{1 2} but their data were collected from a singlerural practice in the United Kingdom, including less than 300patients. A recent population based, case-control study consistingof over 1500 patients has shown that residence in a rural areawas associated with an increased risk of colon cancer (oddsratio 1.4, 95% confidence interval 1.1 to 1.8).³ However, alarge epidemiological study of around 500 000 patients showsthat black men who reside in metropolitan areas have a higherrisk of colorectal cancer than black men who reside in ruralareas.⁴ Both these studies have evaluated populations in theUnited States, but UK populations are similar. It is thereforeimportant to consider both urban and rural . . . [Full text of this article]

Sanjay Purkayastha, clinical research fellow

s.purkayastha@imperial.ac.uk, Department of Biosurgery and Surgical Technology, Imperial College, London W2 1NY

Ara Darzi, professor

Department of Biosurgery and Surgical Technology, Imperial College, London W2 1NY

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