Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis

Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n=19,209) and matched references (n=192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV=3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a diagnostic time window and a potential for earlier diagnosis of CRC based on clinical signs and symptoms. What's new? The sooner cancer is detected, the sooner treatment can begin which improves outcomes. This study asked whether colorectal cancer could be detected earlier in general practice. Using Danish registries, the authors looked at how often people consulted their general practitioner prior to diagnosis with colorectal cancer, compared with a reference population who did not get cancer. They discovered that colorectal cancer patients had met with their general practitioner more frequently in the year leading up to cancer diagnosis, receiving more hemorrhoid medications and hemoglobine counts. This indicates the presence of a diagnostic time window where an earlier diagnosis of CRC may be possible.