• M Elisabeth Del Giudice, Emily T Vella, Amanda Hey, Marko Simunovic, William Harris, and Cheryl Levitt.
• Physician with the Sunnybrook Academic Family Health Team in Toronto, Ont, and is Regional Primary Care Cancer Lead for the Toronto Central Local Health Integration Network. ccopgi@mcmaster.ca.
• Can Fam Physician. 2014 Aug 1; 60 (8): e405-15.

ObjectiveTo systematically review the diagnostic accuracy of clinical features associated with colorectal cancer (CRC) presenting in primary care.Data SourcesMEDLINE and EMBASE were searched for studies in primary care that provided information on clinical features predictive of CRC. Positive predictive values were used to guide the determination of clinical features associated with increased risk of CRC.Study SelectionSystematic reviews or primary studies that provided possible clinical features predictive of CRC were included.SynthesisClinical features of patients presenting in primary care that are associated with increased risk of CRC, listed in descending order of association, included palpable rectal or abdominal mass; rectal bleeding combined with weight loss; iron deficiency anemia; rectal bleeding mixed with stool; rectal bleeding in the absence of perianal symptoms; rectal bleeding combined with change in bowel habits; dark rectal bleeding; rectal bleeding and diarrhea; and change in bowel habits. Being male and increasing age were also, in general, associated with increased risk of CRC.ConclusionRecognition of clinical features associated with increased risk of CRC by FPs might help with earlier identification and referral among patients presenting in primary care. This review might help inform providers and CRC diagnostic assessment programs about indications for assessment and further investigation.Copyright© the College of Family Physicians of Canada.

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