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Predictive value of rectal bleeding in screening for rectal and sigmoid polyps
British Medical Journal (Clinical Research Ed.)
|May 25, 1985
Summary
Rectal bleeding in healthy men over 50 rarely indicates significant polyps or cancer. Flexible sigmoidoscopy screening for this symptom in asymptomatic individuals yields few diagnoses of colorectal cancer or polyps.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Overt rectal bleeding is a common symptom, but its association with undiagnosed colorectal pathology in healthy individuals is not well-established.
- Colorectal cancer and polyps are significant health concerns, necessitating accurate diagnostic approaches.
Purpose of the Study:
- To determine the frequency of undiagnosed rectal or sigmoid polyps or cancer in apparently healthy men aged over 50 who report rectal bleeding.
- To evaluate the diagnostic utility of rectal bleeding as a symptom for detecting colorectal neoplasms.
Main Methods:
- A random sample of 319 healthy men over 50 underwent interviews and flexible sigmoidoscopy up to 30 cm.
- Data collected included reported rectal bleeding in the previous six months and findings from sigmoidoscopy.
Main Results:
- Polyps (≥10 mm) were found in 12 individuals; one had adenocarcinoma. Among 48 reporting bleeding, four had polyps. Among 271 without bleeding, seven polyps and one cancer were found.
- Rectal bleeding showed a specificity of 86%, sensitivity of 33%, and positive predictive value of 8% for polyps or cancer.
- Analyzing stool inspection habits did not enhance the predictive value of rectal bleeding.
Conclusions:
- Flexible sigmoidoscopy in apparently healthy individuals reporting rectal bleeding does not lead to the diagnosis of a significant number of rectal and sigmoid polyps or cancers.
- Rectal bleeding alone is a poor predictor of significant colorectal pathology in asymptomatic, healthy older men.