Department of Surgery and Cancer, Imperial College London, London, UK.
School of Public Health, Imperial College London, London, UK.
Colorectal Dis. 2019 Nov;21(11):1270-1278. doi: 10.1111/codi.14734. Epub 2019 Aug 6.
The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients.
We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records.
The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific.
Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.
50 岁以下人群的结直肠癌发病率正在上升。在这项全国性的基于人群的研究中，我们旨在表明初级保健中存在漏诊机会，导致年轻患者的转诊延迟和紧急诊断。
我们比较了年龄在 50 岁以下和年龄较大的患者的诊断前间隔、主要症状和紧急诊断的比值比（OR），这些患者来源于癌症登记处，并与国家初级保健记录数据库进行了链接。
研究共纳入 7315 例患者，其中 508 例（6.9%）年龄小于 50 岁，1168 例（16.0%）年龄在 50-59 岁之间，2294 例（31.4%）年龄在 60-69 岁之间，3345 例（45.7%）年龄在 70-79 岁之间。年轻患者更可能出现腹痛和紧急就诊，且癌症早期比例最低。他们的转诊和诊断之间的间隔时间比 60-69 岁的患者长（12.5 天），这反映了通过非紧急途径转诊的比例较高（33.3%）。如果在就诊时出现红色警示症状，那么年龄与紧急诊断的 OR 没有差异，但如果症状不典型，则年轻患者的紧急诊断的可能性显著增加。
年轻患者因出现国家转诊指南以外的症状而就诊于初级保健，增加了紧急诊断的可能性。
