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Alarm features of colorectal cancer
  1. G Rubin1,
  2. W Hamilton2
  1. 1
    School of Medicine and Health, Durham University, Stockton on Tees, UK
  2. 2
    National School of Primary Care Research, Bristol, UK
  1. Professor G Rubin, Durham University, Wolfson Research Institute, Queen's Campus, University Boulevard, Stockton on Tees TS17 6BH, UK; greg.rubin{at}sunderland.ac.uk

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The recent systematic review by Ford et al (Gut 2008;57:2545–53) of alarm features of colorectal cancer is a very thorough piece of work. We agree with the conclusion that there is little evidence to support NICE guidance on rapid referral: indeed we have previously drawn attention to this.1 2 However, the study selection employed for this review means that its findings will not be helpful in improving that guidance.

An understanding of the significance of features of possible colorectal cancer must be based on their sensitivity and specificity in the appropriate population. Selection of patients for investigation occurs in primary care; therefore their significance has to be studied using primary care …

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