Introduction
With the rising incidence of early-onset colorectal cancer (EOCRC) in developed countries, it is crucial to improve our understanding of typical signs and symptoms to enable an earlier diagnosis.
Aims & Methods
The aim of this study was to examine the signs, symptoms, tests and prescriptions recorded during two distinct periods prior to the diagnosis of EOCRC: within one month and within one year before diagnosis. Our objective was to identify potential consistent markers that could support earlier diagnosis.
We analysed longitudinal cohort data from three real-world databases from the UK (CPRD GOLD, AURUM, and THINK UK) focusing on patients diagnosed with EOCRC at age 18-49. We performed a large-scale characterization in a random sample of 1,000 individuals with EOCRC (we extracted the signs and symptoms, tests, and prescriptions recorded in patient records). For each, we computed the Relative Risk Increase (RRI) between EOCRC patients and age- and sex-matched controls.
Results
We identified 16,772 cases of EOCRC. In the year leading up to diagnosis, rectal haemorrhage was recorded in 11.5% of EOCRC cases (RRI of 21.2), based on data from CPRD-GOLD. Similarly, abdominal pain and constipation were recorded in 10.7% (RRI 8.4) and 4.8% (RRI 8) of EOCRC cases, based on data from CPRD-Aurum and THIN UK, respectively. Irritable bowel disease (IBS) and iron deficiency anaemia were diagnosed in 4.5% (RRI 6.2) and 4.4% (RRI 4.3), based on data from CPRD-GOLD and CPRD-Aurum respectively. Laboratory tests related to anaemia were more commonly requested among EOCRC patients. For example, serum ferritin was tested in 15.8% of the patients based on data from CPRD-GOLD (RRI of 3.6), and 22.7% based on data from THIN UK (RRI of 2.6). Tissue transglutaminase IgA (for coeliac disease diagnosis) was measured in 6.6% of the patients (RRI 11.8) based on data from CPRD-Aurum. Prescriptions for symptomatic treatments such as dibucaine, butylscopolamine, lactulose, mebeverine, and loperamide were also observed in 3.3-7.7% of cases (RRI of 4.8 to 11.8) across the datasets. Surgical referrals were also more common among EOCRC cases (RRI of 1.2 to 5.6) in the year leading up to diagnosis, with absolute percentages ranging from 4.7% to 6.6%, based on both CPRD databases. This was primarily driven by rectal cases. All these trends were consistent across databases.
In the month preceding diagnosis, clinical activity was dominated by codes related to blood test parameters across all databases.
Conclusion
Signs and symptoms potentially related to CRC were often recorded during the year preceding diagnosis. However, clinical suspicion of CRC remained low in patients under 50, with symptoms frequently attributed to alterative (and potentially co-existing) diagnoses such as haemorrhoids or coeliac disease. While individual symptoms may not always raise clinical concern, combinations of signs, symptoms, and test results could be more informative. Future work should focus on developing predictive tools -potentially incorporating artificial intelligence- to identify individuals at risk based on patterns of clinical features. Such tools could improve early detection and guide timely diagnostic strategies for EOCRC.
References
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