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- Page navigation anchor for Clinical features of bowel disease in patients agedClinical features of bowel disease in patients agedWe thank your correspondents for their interest in our paper.They raise concern that we did not cite their papers, implying therefore that we may not have studied such symptoms as loss of weight, loss of appetite or abdominal distension. We can assure them that we did indeed study these symptoms (they were either too uncommon, or were negative) - as stated in our paper, we studied all symptoms, signs and investigations that had previously been reported as associated with CRC/IBD.Regarding the well-accepted status of our methodology, we refer the correspondents to the fourteen adult CAPER studies published, plus one in press, and the three childhood ones, including a Research Paper of the Year (references available on request), all in high quality journals. This methodology dates back to the pioneering days of Knut Holtedahl in the late 80s.1-3 Concerns over case-control studies largely relate to worries over the potential bias from selection of cases. However, as we took all colorectal cancer and IBD patients that were present in the CPRD during our timeframe, this concern is essentially eliminated. Our method of case identification (a code in electronic primary care records) is the same method of identifying cases as your correspondents also use in their cancer research, of course. We agree that we have not yet validated the tool – though made no claims in the paper to have done so....Show MoreCompeting Interests: Unchanged from those declared with the article.
- Page navigation anchor for Concerns on 'clinical features of bowel disease paper in patientsConcerns on 'clinical features of bowel disease paper in patients
We have some significant concerns regarding the recent paper Stapely et al published in a recent edition of the BJGP.1
- They state that “all symptoms, signs and investigations that had previously been reported as associated with CRC/IBD were studied”. However, the paper fails to cite four papers, all published in the BJGP, which examine and validate the predictive value of symptoms for predicting colorectal cancer.2-5 This is a major omission especially since these papers2-5 were cited in the NICE guidance on suspected cancer.6
- There is no clear list of which variables were tested. Did they include weight loss, appetite loss and abdominal distension which are all independently and significantly associated with a 2-3 fold increased risk of colorectal cancer.2-5 These studies were included in the NICE guideline meta-analysis of weight loss as a predictive symptom for colorectal cancer. Did the authors analyse these variables and what were the results? If there is no association between weight loss and risk of colorectal cancer, then this is an important negative finding and should be highlighted.
- They state their "methodology is well accepted" although, the NICE guideline raised concerns about the use of the case control design (page 106), known to be associated with bias and inflated risk estimat...
Competing Interests: JHC is professor of clinical epidemiology at the University of Nottingham and co-director of QResearch® – a not-for-profit organisation which is a joint partnership between the University of Nottingham and Egton Medical Information Systems (leading commercial supplier of IT for 60% of general practices in the UK). JHC is also a paid director of ClinRisk Ltd which produces open and closed source software to ensure the reliable and updatable implementation of clinical risk equations within clinical computer systems to help improve patient care. CC is Professor of Medical Statistics at the University of Nottingham and a paid consultant statistician for ClinRisk Ltd. JHC and CC are authors of the QCancer papers. This work and any views expressed within it are solely those of the co-authors and not of any affiliated bodies or organisations.