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Title: A study of family history, deprivation and comorbidity in colorectal cancer
Author: Cetnarskyj, Roseanne
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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A prospective study of 1540 colorectal cancer cases aged 16-79, diagnosed in Scotland between 3rd January 2002 and 31st December 2003, was conducted. The main aims are: report the number and proportion of cases that perceive they have a family history risk of colorectal cancer; compare waiting time with symptoms and behaviour after development of symptoms, between cases that perceive a family history risk and do not perceive a family history risk; report the number and proportion of cases in this cohort with a family history of colorectal cancer that meet Scottish clinical criteria for high or moderate family history risk. A secondary aim is: describe the average delay time in symptom presentation and the factors contributing to delay in presentation of lower gastrointestinal symptoms among cases with colorectal cancer and in particular assess the importance of deprivation and comorbidity. Results: The distribution of sex and age at diagnosis were similar to other published population-based colorectal cancer studies. Of the 1540 cases, 222 (14.9%) cases perceived they had a family history of colorectal cancer. 280 (18.2%) cases out of 1540 were at a high or moderate family history risk according to Scottish Executive Guidelines. Of these 280 cases, 133 (47.5%) perceived they had a family history of colorectal cancer. Of these 133 cases, only 51 (18.2%) discussed this concern with their GP and, only 12 (4.3%) were referred to cancer genetic services. Cases that perceived a family history risk of colorectal cancer were more likely to state they have knowledge of colorectal cancer symptoms and more likely to think that the lower gastrointestinal symptoms they develop are symptoms of colorectal cancer. However, this knowledge does not prompt them to visit the GP with less delay after symptoms onset than those cases with no perception of a family history risk of colorectal cancer. There was no association found between deprivation, comorbidity and timing of presentation following development of symptoms. The more deprived group of patients were significantly more likely to report no knowledge of colorectal cancer symptoms. They were also less likely not to inspect the toilet or the toilet paper before flushing. Implications for Health service: Providing all health professionals with the knowledge and skills to take a family history and to follow published guidelines when assessing family history risk would share the responsibility for identification of individuals with a high or moderate family, improve the appropriateness of referrals and reduce the inequality in access to cancer genetic services. The most deprived group of patients have the least knowledge of colorectal cancer symptoms and the design of educational material should acknowledge this fact and ensure that it is appropriate for this audience.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available