![]() 11, 14 The American College of Gastroenterology does not recommend performing colonoscopies on non-bleeding patients with CIBH. 11 – 13 However, CIBH as a sole trigger for fast track colonoscopy evaluation is disputed: a 2008 meta-analysis and a 2011 systematic review found overall poor positive and negative likelihood ratios for CIBH, with a statistical heterogeneity of results between the included studies. 10 Unexplained visible rectal bleeding and iron deficiency anaemia are well-established CRC alarm features that often lead to prompt referrals for colonoscopy. 9 The most common symptoms and clinical features include weight loss, anaemia, abdominal pain, rectal bleeding and change in bowel habit (CIBH). Presenting features of CRC are often non-specific and vary considerably between individuals. Although screening programmes are highly effective for early diagnosis and prevention, 6, 7 the majority of CRC patients still encounter healthcare services only after symptom manifestation. 4, 5 In an attempt to establish earlier diagnoses, health authorities across Europe have implemented different national screening programmes and symptom-based investigative pathways for CRC. 3 Although 5-year survival rates for CRC are over 90% when diagnosed early, they decrease considerably with cancer stage progression. 2 Overall, CRC has a higher prevalence in men than in women, and the likelihood of developing the condition increases markedly after 50 years of age. ![]() Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death in Europe, 1 with a predicted 98,000 deaths in 2018.
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