{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:28:31Z","timestamp":1777692511346,"version":"3.51.4"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":1326,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The aim of this study was to identify characteristics with independent predictive value for bowel cancer for use in the clinical assessment of patients attending colorectal outpatient clinics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a 22-year (1986\u20132007) retrospective cohort analysis of data collected prospectively from patients who attended colorectal surgical outpatient clinics in Portsmouth. The data set was split randomly into two groups of patients to generate and validate a predictive model. Multivariable logistic regression was used to create and validate a system to predict outcome. Receiver operating characteristic (ROC) curves and Hosmer\u2013Lemeshow test were used to evaluate the model's predictive capability. The likelihood of bowel cancer was expressed as the odds ratio (OR).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data from 29 005 patients were analysed. Discrimination of the model for bowel cancer was high in the development (C-statistic 0\u00b787, 95 per cent c.i. 0\u00b785 to 0\u00b788) and validation (C-statistic 0\u00b786, 0\u00b784 to 0\u00b787) groups. The most important co-variables in the final model were: age (OR 3\u00b717\u201327\u00b710), rectal (OR 31\u00b748) or abdominal (OR 1\u00b783\u20138\u00b745) mass, iron deficiency anaemia (IDA) (OR 4\u00b742\u20138\u00b738), rectal bleeding and change in bowel habit in combination (OR 5\u00b737), change in bowel habit without rectal bleeding, with or without abdominal pain (OR 2\u00b712\u20132\u00b752), and rectal bleeding with no perianal symptoms and without change in bowel habit (OR 2\u00b791). Some 91\u00b75 per cent of bowel cancers presented with these characteristics, 40\u00b74 per cent with a mass and\/or IDA. In patients with at least one of these characteristics the overall risk of having cancer was 10\u00b70 (range 6\u00b75\u201350\u00b74) per cent, compared with 1\u00b71 (0\u00b73\u20132\u00b73) per cent in patients without them.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A clinical assessment that systematically identifies or excludes four symptom\u2013age combinations, a mass and IDA (SAMI) stratifies patients as having a low and higher risk of having bowel cancer. This could improve patient selection for referral and investigation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.10573","type":"journal-article","created":{"date-parts":[[2017,6,21]],"date-time":"2017-06-21T08:46:36Z","timestamp":1498034796000},"page":"1393-1404","source":"Crossref","is-referenced-by-count":50,"title":["Clinical assessment to determine the risk of bowel cancer using Symptoms, Age, Mass and Iron deficiency anaemia (SAMI)"],"prefix":"10.1093","volume":"104","author":[{"given":"M R","family":"Thompson","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D P","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4829-9879","authenticated-orcid":false,"given":"K","family":"Flashman","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Asiimwe","sequence":"additional","affiliation":[{"name":"Bayer Pharma AG, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B G","family":"Ellis","sequence":"additional","affiliation":[{"name":"Swan Surgery General Practice, Petersfield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Senapati","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,6,21]]},"reference":[{"key":"2021020617363455800_bjs10573-bib-0001","author":"Cancer Research","year":"2014","journal-title":"Bowel Cancer Survival Statistics"},{"key":"2021020617363455800_bjs10573-bib-0002","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1463-1318.2009.01986.x","article-title":"Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival?","volume":"13","author":"Thompson","year":"2011","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0003","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/bmj.311.7003.486","article-title":"Rectal bleeding: prevalence and consultation behaviour","volume":"311","author":"Crosland","year":"1995","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0004","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/j.1572-0241.1998.00530.x","article-title":"Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking","volume":"93","author":"Talley","year":"1998","journal-title":"Am J Gastroenterol"},{"key":"2021020617363455800_bjs10573-bib-0005","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/BF01537261","article-title":"A longitudinal survey of self-reported bowel habits in the United States","volume":"34","author":"Everhart","year":"1989","journal-title":"Dig Dis Sci"},{"key":"2021020617363455800_bjs10573-bib-0006","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/0016-5085(90)91023-Y","article-title":"Epidemiology of irritable bowel syndrome in the United States","volume":"99","author":"Sandler","year":"1990","journal-title":"Gastroenterology"},{"key":"2021020617363455800_bjs10573-bib-0007","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1046\/j.1463-1318.2000.00141.x","article-title":"Rectal bleeding in general and hospital practice; \u2018the tip of the iceberg\u2019","volume":"2","author":"Thompson","year":"2000","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0008","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/fampra\/10.4.387","article-title":"Abdominal pain in general practice","volume":"10","author":"Muris","year":"1993","journal-title":"Fam Pract"},{"key":"2021020617363455800_bjs10573-bib-0009","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1136\/bmj.304.6819.87","article-title":"Irritable bowel syndrome in the general population","volume":"304","author":"Jones","year":"1992","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0010","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1016\/0016-5085(92)90320-X","article-title":"Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters","volume":"102","author":"Heaton","year":"1992","journal-title":"Gastroenterology"},{"key":"2021020617363455800_bjs10573-bib-0011","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1136\/bmj.327.7409.263","article-title":"Identifying and managing patients at low risk of bowel cancer in general practice","volume":"327","author":"Thompson","year":"2003","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0012","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1017\/S0266462309990407","article-title":"Systematic review of economic evidence for the detection, diagnosis, treatment and follow up of colorectal cancer in the United Kingdom","volume":"25","author":"Tappenden","year":"2009","journal-title":"Int J Technol Assess Health Care"},{"key":"2021020617363455800_bjs10573-bib-0013","author":"GOV.UK","year":"2011","journal-title":"Bowel Cancer Awareness Campaign to go National"},{"key":"2021020617363455800_bjs10573-bib-0014","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1046\/j.1463-1318.2002.00348.x","article-title":"ACPGBI Referral Guidelines for colorectal cancer","volume":"4","author":"Thompson","year":"2002","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0015","first-page":"h2418","article-title":"Suspected cancer (part 2 \u2013 adults): visual overview of updated NICE guidance","volume":"350","author":"Hamilton","year":"2015","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0016","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1136\/gut.47.4.533","article-title":"Understanding variations for colorectal cancer in Europe: a EUROCARE high-resolution study","volume":"47","author":"Gatta","year":"2000","journal-title":"Gut"},{"key":"2021020617363455800_bjs10573-bib-0017","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1136\/gut.2004.044214","article-title":"Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery","volume":"54","author":"Ciccolallo","year":"2005","journal-title":"Gut"},{"key":"2021020617363455800_bjs10573-bib-0018","first-page":"871","article-title":"Disease awareness campaigns turn healthy people into patients","volume":"332","author":"Dyer","year":"2006","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0019","doi-asserted-by":"crossref","first-page":"A241","DOI":"10.1136\/gutjnl-2014-307263.519","article-title":"United Kingdom National Bowel Cancer Awareness Programme \u2013 more pain, no gain","volume":"63","author":"Khong","year":"2014","journal-title":"Gut"},{"key":"2021020617363455800_bjs10573-bib-0020","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1111\/codi.12220","article-title":"\u2018Be Clear on Cancer\u2019: the impact of the UK National Bowel Cancer Awareness Campaign","volume":"8","author":"Peacock","year":"2013","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0021","author":"National Cancer Registration and Analysis Service (NCRAS)","year":"2014","journal-title":"General Practice Profiles"},{"key":"2021020617363455800_bjs10573-bib-0022","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1136\/bmj.c2800","article-title":"Why medicine is overweight","volume":"340","author":"Martyn","year":"2010","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0023","volume-title":"Effectiveness and Efficiency. Random Reflections on the Health Services","author":"Cochrane","year":"1972"},{"key":"2021020617363455800_bjs10573-bib-0024","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/S0140-6736(02)09549-1","article-title":"Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study","volume":"360","author":"Selvachandran","year":"2002","journal-title":"Lancet"},{"key":"2021020617363455800_bjs10573-bib-0025","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1136\/gut.2010.225987","article-title":"The diagnostic performance of scoring systems to identify symptomatic colorectal cancer compared to current referral guidance","volume":"60","author":"Marshall","year":"2011","journal-title":"Gut"},{"key":"2021020617363455800_bjs10573-bib-0026","first-page":"949","article-title":"Factors identifying higher risk bleeding in general practice","volume":"55","author":"Ellis","year":"2005","journal-title":"Br J Gen Pract"},{"key":"2021020617363455800_bjs10573-bib-0027","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1002\/bjs.5826","article-title":"Predictive value of the common symptom combinations in diagnosing colorectal cancer","volume":"94","author":"Thompson","year":"2007","journal-title":"Br J Surg"},{"key":"2021020617363455800_bjs10573-bib-0028","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/sj.bjc.6605426","article-title":"Diagnostic accuracy systemic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer","volume":"102","author":"Olde Bekkink","year":"2010","journal-title":"Br J Cancer"},{"key":"2021020617363455800_bjs10573-bib-0029","doi-asserted-by":"crossref","first-page":"c1269","DOI":"10.1136\/bmj.c1269","article-title":"Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis","volume":"340","author":"Jellema","year":"2010","journal-title":"BMJ"},{"key":"2021020617363455800_bjs10573-bib-0030","doi-asserted-by":"crossref","first-page":"e231","DOI":"10.3399\/bjgp11X572427","article-title":"The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review","volume":"61","author":"Astin","year":"2011","journal-title":"Br J Gen Pract"},{"key":"2021020617363455800_bjs10573-bib-0031","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/00000658-195508000-00002","article-title":"Clinical evaluation of 750 patients with colon cancer. Diagnostic survey and follow up covering a 15 year period","volume":"142","author":"Shallow","year":"1955","journal-title":"Ann Surg"},{"key":"2021020617363455800_bjs10573-bib-0032","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/00000658-196904000-00005","article-title":"Carcinoma of the colon and rectum","volume":"169","author":"McSherry","year":"1969","journal-title":"Ann Surg"},{"key":"2021020617363455800_bjs10573-bib-0033","author":"NHS Public Health England","year":"2017","journal-title":"The National Cancer Registration and Analysis Service"},{"key":"2021020617363455800_bjs10573-bib-0034","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1002\/bjs.6234","article-title":"Flexible sigmoidoscopy and whole colonic imaging in the diagnosis of cancer in patients with colorectal symptoms","volume":"95","author":"Thompson","year":"2008","journal-title":"Br J Surg"},{"key":"2021020617363455800_bjs10573-bib-0035","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1245\/ASO.2006.05.040","article-title":"Prognostic score in gastric cancer: the importance of a conjoint analysis of clinical, pathologic, and therapeutic factors","volume":"13","author":"Costa","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"2021020617363455800_bjs10573-bib-0036","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"Hanley","year":"1982","journal-title":"Radiology"},{"key":"2021020617363455800_bjs10573-bib-0037","doi-asserted-by":"crossref","DOI":"10.1002\/0471722146","volume-title":"Applied Logistic Regression","author":"Hosmer","year":"2000","edition":"2nd"},{"key":"2021020617363455800_bjs10573-bib-0038","first-page":"46","article-title":"Comparison of stopping rules in forward regression","volume":"72","author":"Bendel","year":"1977","journal-title":"J Am Stat Assoc"},{"key":"2021020617363455800_bjs10573-bib-0039","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/oxfordjournals.aje.a115101","article-title":"A study of the impact of confounder-selection criteria on effect estimation","volume":"129","author":"Mickey","year":"1989","journal-title":"Am J Epidemiol"},{"key":"2021020617363455800_bjs10573-bib-0040","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1741-7015-7-17","article-title":"The risk of colorectal cancer with symptoms at different ages and between the sexes: a case\u2013control study","volume":"7","author":"Hamilton","year":"2009","journal-title":"BMC Med"},{"key":"2021020617363455800_bjs10573-bib-0041","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.3399\/bjgp12X616346","article-title":"Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm","volume":"62","author":"Hippisley-Cox","year":"2012","journal-title":"Br J Gen Pract"},{"key":"2021020617363455800_bjs10573-bib-0042","author":"Bowel Cancer Information","year":"2017","journal-title":"Bowel Symptom Checker"},{"key":"2021020617363455800_bjs10573-bib-0043","author":"NHS Choices","year":"2015","journal-title":"Bowel Cancer Symptom Checker"},{"key":"2021020617363455800_bjs10573-bib-0044","doi-asserted-by":"crossref","first-page":"276","DOI":"10.5694\/j.1326-5377.1969.tb92124.x","article-title":"The \u2018red herring\u2019 barium-meal X-ray examination in carcinoma of the right side of the colon","volume":"1","author":"Fagan","year":"1969","journal-title":"Med J Aust"},{"key":"2021020617363455800_bjs10573-bib-0045","volume-title":"Towards improving outcomes for colorectal cancer","author":"Mohammed","year":"2002"},{"key":"2021020617363455800_bjs10573-bib-0046","first-page":"23","article-title":"Family history in colorectal cancer: a weak association in younger symptomatic patients","volume":"1","author":"Nichols","year":"1999","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0047","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.1038\/sj.bjc.6605396","article-title":"The CAPER studies: five case\u2013control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients","volume":"101","author":"Hamilton","year":"2009","journal-title":"Br J Cancer"},{"key":"2021020617363455800_bjs10573-bib-0048","volume-title":"The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style (2nd edn)","author":"Neighbour","year":"2005"},{"key":"2021020617363455800_bjs10573-bib-0049","doi-asserted-by":"crossref","first-page":"e508","DOI":"10.3399\/bjgp11X588484","article-title":"Are the serious problems in cancer survival partly rooted in gatekeeper principles?","volume":"61","author":"Vedsted","year":"2011","journal-title":"Br J Gen Pract"},{"key":"2021020617363455800_bjs10573-bib-0050","volume-title":"Diagnosing Cancer in Primary Care","author":"Summerton","year":"1999"},{"key":"2021020617363455800_bjs10573-bib-0051","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/S0140-6736(96)03386-7","article-title":"Randomised control trial of faecal occult blood screening for colorectal cancer","volume":"348","author":"Hardcastle","year":"1996","journal-title":"Lancet"},{"key":"2021020617363455800_bjs10573-bib-0052","doi-asserted-by":"crossref","DOI":"10.3310\/hta21660","article-title":"Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study","author":"Atkin","year":"2017","journal-title":"Health Technol Assess"},{"key":"2021020617363455800_bjs10573-bib-0053","first-page":"12","article-title":"How does bowel cancer present? Implications for DoH plans to achieve earlier diagnosis","volume":"14","author":"Thompson","year":"2012","journal-title":"Colorectal Dis"},{"key":"2021020617363455800_bjs10573-bib-0054","first-page":"17","article-title":"The UK DoH public awareness campaign will have little effect on reducing emergency admissions of patients with bowel cancer","volume":"15","author":"Thompson","year":"2013","journal-title":"Colorectal Dis"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.10573","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/104\/10\/1393\/36207739\/bjs10573.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/104\/10\/1393\/36207739\/bjs10573.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T14:18:17Z","timestamp":1621520297000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/104\/10\/1393-1404\/6095239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,21]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2017,6,21]]},"published-print":{"date-parts":[[2017,8,7]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.10573","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,9]]},"published":{"date-parts":[[2017,6,21]]}}}