{
  "abstract": "Objectives Body mass index (BMI) confers a higher risk of colorectal cancer (CRC) and may influence cancer diagnostic pathways. We investigated variations in diagnostic pathways by BMI category among patients with symptomatic CRC.Design Retrospective cohort study using linked cancer registry, primary, and secondary care data.Setting EnglandParticipants 5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015.Primary and secondary outcome measures Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use.Results Red-flag symptoms (change in bowel habit, rectal bleeding) were more frequently recorded among patients with rectal cancer with obesity and overweight versus normal weight (65.2% and 65.5% vs 56.8%, respectively). Among colon cancer patients endoscopy during the year pre-diagnosis was used in a greater proportion of patients with obesity versus normal weight (72.8% vs 64.4%, p<0.001). Among patients with colon cancer with red-flag symptoms, being overweight versus normal weight was associated with higher odds of fast-track referral compared with diagnosis through other routes (OR: 1.48, 95% CI 1.16 to 1.88). Obesity was associated with lower odds of emergency presentation, compared with normal weight (colon 23.6% vs 32.1%; adjusted OR: 0.72, 95% CI 0.57 to 0.90; rectum 8.3% vs 14.8%; OR: 0.57, 95% CI 0.35 to 0.92).Conclusions Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients.",
  "authors": [
    {
      "affiliations": [
        "UCL Institute of Epidemiology and Health Care, London, UK"
      ],
      "name": "Jessica Sarah Kurland"
    },
    {
      "affiliations": [
        "UCL Institute of Epidemiology and Health Care, London, UK"
      ],
      "name": "Aradhna Kaushal"
    },
    {
      "affiliations": [
        "Inequalities in Cancer Outcomes Network (ICON) Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Sara Benitez Majano"
    },
    {
      "affiliations": [
        "Epidemiology of Cancer Healthcare & Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, UCL Institute of Epidemiology and Health Care, London, UK"
      ],
      "name": "Georgios Lyratzopoulos"
    },
    {
      "affiliations": [
        "Epidemiology of Cancer Healthcare & Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, UCL Institute of Epidemiology and Health Care, London, UK",
        "Faculty of Medicine, Università Vita Salute San Raffaele, Milan, Italy"
      ],
      "name": "Cristina Renzi"
    }
  ],
  "title": "Variations in symptoms, endoscopy use and emergency diagnosis of colorectal cancer by body mass index: a retrospective cohort study using linked electronic health records in England",
  "uid": "408a2958-a45b-55ad-b4e1-e04d244511d7"
}