Diagnostic utility of alarm features for colorectal cancer: systematic review and meta-analysis

Ford, A. C.; van Zanten, S. J. O. Veldhuyzen; Rodgers, C. C.; TaIIey, N. J.; Vakil, N. B.; Moayyedi, P.
November 2008
Gut;Nov2008, Vol. 57 Issue 11, p1545
Academic Journal
Objective: Colorectal cancer is the second most common cause of cancer death in Europe and North America. Alarm features are used to prioritise access to urgent investigation, but there is little information concerning their utility in the diagnosis of colorectal cancer. Methods: A systematic review and meta-analysis of the published literature was carried out to assess the diagnostic accuracy of alarm features in predicting colorectal cancer. Primary or secondary care-based studies in unselected cohorts of adult patients with lower gastrointestinal symptoms were identified by searching MEDLINE, EMBASE and CINAHL (up to October 2007). The main outcome measures were accuracy of alarm features or statistical models in predicting the presence of colorectal cancer after investigation. Data were pooled to estimate sensitivity, specificity, and positive and negative likelihood ratios. The quality of the included studies was assessed according to predefined criteria. Results: Of 11169 studies identified, 205 were retrieved for evaluation. Fifteen studies were eligible for inclusion, evaluating 19 443 patients, with a pooled prevalence of colorectal carcinoma of 6% (95% Cl 5% to 8%). Pooled sensitivity of alarm features was poor (5% to 64%) but specificity was >95% for dark red rectal bleeding and abdominal mass, suggesting that the presence of either rules the diagnosis of colorectal cancer in. Statistical models had a sensitivity of 90%, but poor specificity. Conclusions: Most alarm features had poor sensitivity and specificity for the diagnosis of colorectal carcinoma, whilst statistical models performed better in terms of sensitivity. Future studies should examine the utility of dark red rectal bleeding and abdominal mass, and concentrate on maximising specificity when validating statistical models.


Related Articles

  • Editorial: PDR or ADR as a Quality Indicator for Colonoscopy. Leung, Felix W // American Journal of Gastroenterology;Jun2013, Vol. 108 Issue 6, p1000 

    Interval (missed) cancers and lower-than-expected mortality reduction of proximal colon cancers after screening colonoscopy drew attention to quality indicators. Small proximal polyps (prone to be advanced neoplasms) missed by colonoscopy are possible contributing factors. In this issue of AJG,...

  • Bowel screening scheme detecting cancer earlier.  // Pulse;11/11/2009, Vol. 69 Issue 36, p14 

    The article reports on the study on the effectiveness of the National Bowel Cancer Screening program in Wolverhampton, England. It is stated that the research found that 45 percent of screened colorectal cancer patients are in the earliest stage or stage A, while 22 percent are in stage B. It...

  • Quantifying the Potential Benefit of Sigmoidoscopic Rescreening for Colorectal Cancer. Weiss, Noel S.; Newcomb, Polly A. // JNCI: Journal of the National Cancer Institute;Feb2012, Vol. 104 Issue 4, p259 

    The article looks at the potential benefit of sigmoidoscopy in the detection of colorectal cancer. It suggests to conduct randomized trials to investigate the occurrence of cancer mortality in persons who received different rescreening frequencies. It recommends the use of data from studies on...

  • Eleven Candidate Susceptibility Genes for Common Familial Colorectal Cancer. Gylfe, Alexandra E.; Katainen, Riku; Kondelin, Johanna; Tanskanen, Tomas; Cajuso, Tatiana; Hänninen, Ulrika; Taipale, Jussi; Taipale, Minna; Renkonen-Sinisalo, Laura; Järvinen, Heikki; Mecklin, Jukka-Pekka; Kilpivaara, Outi; Pitkänen, Esa; Vahteristo, Pia; Tuupanen, Sari; Karhu, Auli; Aaltonen, Lauri A. // PLoS Genetics;Oct2013, Vol. 9 Issue 10, p1 

    Hereditary factors are presumed to play a role in one third of colorectal cancer (CRC) cases. However, in the majority of familial CRC cases the genetic basis of predisposition remains unexplained. This is particularly true for families with few affected individuals. To identify susceptibility...

  • Colonoscopy vs Sigmoidoscopy: New Studies Fuel Ongoing Debate. Schmidt, Charlie // JNCI: Journal of the National Cancer Institute;9/19/2012, Vol. 104 Issue 18, p1350 

    The article discusses studies that fuelled debates over endoscopy in screening colorectal cancer. A study by Robert Schoen et al in the May 21, 2012 issue of the "New England Journal of Medicine" showed that sigmoidoscopy reduced colon cancer incidence by 21% and mortality by 50%. Nancy Baxter...

  • Flexible Sigmoidoscopy: More Than a Unilateral Breast Exam? Bresalier, Robert // Digestive Diseases & Sciences;Mar2015, Vol. 60 Issue 3, p634 

    No abstract available.

  • How Does the Serrated Polyp Pathway Alter CRC Screening and Surveillance? Kahi, Charles // Digestive Diseases & Sciences;Mar2015, Vol. 60 Issue 3, p773 

    Screening and surveillance for colorectal cancer (CRC) reduces mortality through the detection of early-stage adenocarcinoma, and more importantly the detection and removal of premalignant polyps. While adenomas have historically been considered the most common and screening-relevant precursor...

  • Rectal bleeding and colorectal cancer in general practice: diagnostic study. Wauters, Hans; Van Casteren, Viviane; Buntinx, Frank // BMJ: British Medical Journal (International Edition);10/21/2000, Vol. 321 Issue 7267, p998 

    Presents a study of the diagnostic value of rectal bleeding in relation to a potential diagnosis of colorectal cancer. Analysis of data on patients who, after initially presenting with rectal bleeding, were diagnosed with cancer; Symptoms associated with rectal bleeding; Statistics for the...

  • Factors Influencing Colorectal Cancer Screening Participation. Garcĺa, Antonio Z. Gimeno // Gastroenterology Research & Practice;2012, p1 

    Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening...


Read the Article


Sign out of this library

Other Topics