Intended for healthcare professionals


Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study

BMJ 2006; 333 doi: (Published 06 July 2006) Cite this as: BMJ 2006;333:69
  1. Jennifer du Toit, general practitioner (kbarraclough{at},
  2. William Hamilton, senior research fellow2,
  3. Kevin Barraclough, general practitioner1
  1. 1 Hoyland House, Painswick, Gloucestershire GL6 6RD
  2. 2 Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol BS8 1AU
  1. Correspondence to: J du Toit
  • Accepted 3 May 2006


Objective To measure the risk of colorectal cancer and adenoma with new onset rectal bleeding reported to primary care.

Design Cohort study.

Setting A rural general practice in the United Kingdom.

Participants Patients aged 45 or more with new onset rectal bleeding, irrespective of other symptoms.

Main outcome measures Percentage of participants in whom colorectal cancer or colonic adenoma was identified after investigation of the bowel.

Results During a 10 year period, 265 patients reported new rectal bleeding. Of these, 15 (5.7%, 95% confidence interval 3.2% to 9.2%) had colorectal cancer, and 13 (4.9%, 2.6% to 8.4%) had colonic adenoma. Only two of the patients with cancer had had diarrhoea.

Conclusions One in 10 patients aged 45 or more with new onset rectal bleeding had colonic neoplasia, so investigation of the bowel should be offered to all such patients, whether or not they have other symptoms.


  • Contributors KB and JdT were involved in all aspects of the study. WH performed the analyses and wrote the initial draft. JdT is guarantor.

  • Funding WH is funded by his research practice (Barnfield Hill, Exeter) and an NHS researcher development award. Competing interests: None declared.

  • Ethical approval Gloucester local research ethics committee.

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