The University of Exeter, in partnership with Bowel Cancer UK Never Too Young campaign, Durham University and North Tees and Hartlepool NHS Foundation Trust, today publishes in the British Journal of General Practice a new research and risk assessment tool.

Funded by the Department of Health, this tool aims to support GPs to identify the symptoms of a serious bowel condition for patients aged under-50.

This research comes ahead of Bowel Cancer Awareness Month in April.

The assessment tool will calculate the risk of a serious bowel condition allowing the GP to decide whether a patient needs further tests.

This is the first of its kind for younger people and aims to speed up the diagnosis of patients under 50 who often experience significant delays.

Lower gastrointestinal (GI) symptoms are common and in younger people are often attributed to non-serious conditions, like Irritable bowel syndrome (IBS).

But we know there are more than 2,500 new diagnoses of bowel cancer every year in under 50s in the UK and approximately 13,000 people are diagnosed with inflammatory bowel disease, many of these also under the age of 50.

Symptoms of these conditions account for one in 12 GP appointments, but given that most of these symptoms won’t be caused by bowel cancer, it can be difficult for GPs to distinguish between those patients with non-serious conditions, such as IBS, and serious conditions, like bowel cancer and inflammatory bowel disease.

Using data from the well-established Clinical Practice Research Datalink (CPRD), a high quality national database representative of the UK as a whole, the researchers assessed the frequency of symptoms in people with a serious bowel condition, and used this to calculate the positive predictive value (PPV) of bowel cancer or inflammatory bowel disease.

Using symptoms, a physical examination and blood test results, the tool calculates the PPV of a serious disease with a percentage, as well as suggesting next steps:

• Risk level <1%:  The GP should monitor the patient’s progress, but at this stage no further tests are needed.
• Risk level 1-3%: The GP should recommend the patient for a faecal calprotectin test to help rule out a non-serious condition like Irritable bowel syndrome (IBS).
• Risk level >3%: The GP should refer the patient for an urgent colonoscopy or refer the patient to a specialist for further assessment.

The tool recommends that patients with a risk threshold of 3% or more should have further urgent investigation, an action which is in line with NICE referral guidelines for suspected cancer and the NICE Quality Standard for inflammatory bowel disease.

Willie Hamilton, Professor of Primary Care Diagnostics at the University of Exeter Medical School, who led the research says:  “The risk assessment tool should be used as a reminder to GPs to consider the likelihood of an individual patient having a serious bowel condition given the symptom or combination of symptoms they present with. The tool does not replace clinical judgement but provides more information to base a referral decision.”

Deborah Alsina MBE, Chief Executive, Bowel Cancer UK, says: “As the numbers of under-50s affected by bowel cancer and bowel disease continues to rise, research is fundamental in finding better ways to diagnose people early when treatment is likely to be more successful.

“We launched our flagship Never Too Young campaign in 2013 to highlight the experiences of young people for the first time and to improve their diagnosis, treatment and care so that more lives are saved. Delayed diagnosis is all too common for young patients with both bowel cancer and inflammatory bowel disease therefore finding quicker, more effective ways to identify and diagnose these patients earlier is crucial. Our research shows that one in five young patients have to visit their GP five times or more before they get their diagnosis and this is simply not acceptable.

“This important research has the potential to help GPs to decide which of their young patients need a referral for further tests and which have less serious bowel conditions. However this is just the start, the next step is to ensure that all GPs across the UK have access to this potentially life-saving tool as part of their day to day practice”

Source: Bowel Cancer UK