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Editor - In Weller's editorial (1) on the paper by du Toit et al (2)
he comments “The study found that about one in 10 patients with new onset
rectal bleeding had cancer”. This summary statement is misleading on two
counts.
Firstly the authors found that a new episode of rectal bleeding in
patients aged 45 or more had a positive predictive value for colorectal
cancer of 5.7%, whilst this symptom predicted adenoma in 4.9%. They
conclude that overall one in 10 patients had colorectal neoplasia, not
colorectal cancer. Weller has inaccurately lumped together adenoma with
carcinoma. Adenoma carries a varying risk for the development of colon
cancer depending on histology but overall this risk is approximately 5%
(3).
Secondly as only patients aged 45 or more were included, any summary
statement must surely highlight this important demographic.
We do not feel that this statement correctly summarises the study and
is likely to cause undue concern to the many patients aged less than 45
years with rectal bleeding about whom no data has been presented in this
study.
1 Weller D. Colorectal cancer in primary care. BMJ 2006;333:54-5.
2 du Toit J, Hamilton W, Barraclough K. Risk in primary care of
colorectal cancer from new onset rectal bleeding: 10 year prospective
study. BMJ 2006;333:69-70.
3 Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of
Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 809-818.
Risk of colorectal cancer with rectal bleeding
Editor - In Weller's editorial (1) on the paper by du Toit et al (2)
he comments “The study found that about one in 10 patients with new onset
rectal bleeding had cancer”. This summary statement is misleading on two
counts.
Firstly the authors found that a new episode of rectal bleeding in
patients aged 45 or more had a positive predictive value for colorectal
cancer of 5.7%, whilst this symptom predicted adenoma in 4.9%. They
conclude that overall one in 10 patients had colorectal neoplasia, not
colorectal cancer. Weller has inaccurately lumped together adenoma with
carcinoma. Adenoma carries a varying risk for the development of colon
cancer depending on histology but overall this risk is approximately 5%
(3).
Secondly as only patients aged 45 or more were included, any summary
statement must surely highlight this important demographic.
We do not feel that this statement correctly summarises the study and
is likely to cause undue concern to the many patients aged less than 45
years with rectal bleeding about whom no data has been presented in this
study.
1 Weller D. Colorectal cancer in primary care. BMJ 2006;333:54-5.
2 du Toit J, Hamilton W, Barraclough K. Risk in primary care of
colorectal cancer from new onset rectal bleeding: 10 year prospective
study. BMJ 2006;333:69-70.
3 Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of
Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 809-818.
Competing interests:
None declared
Competing interests: No competing interests