Open Access Research article

Patients who take their symptoms less seriously are more likely to have colorectal cancer

Barbara-Ann Adelstein1*, Petra Macaskill2, Robin M Turner2 and Les Irwig2

Author Affiliations

1 Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia

2 Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia

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BMC Gastroenterology 2012, 12:130  doi:10.1186/1471-230X-12-130

Published: 22 September 2012



People vary in how they respond to symptoms. The purpose of this study was to assess whether serious disease is more likely to be present in patients who report that they take any symptoms less seriously than other people do, and to assess the reliability of a question which can be used to identify the extent to which patients take any symptom seriously. To do this we assessed whether the likelihood of detecting colorectal cancer is higher in patients who report that they take symptoms less seriously than other people do.


Cross sectional study of 7736 patients who had colonoscopy to find colorectal cancer. Before colonoscopy, patients completed a questionnaire on bowel symptoms and were also asked: “Compared to other people of your age and sex, how seriously do you think you take any symptoms?” Likelihood of detecting colorectal cancer according to responses to this question was assessed by logistic regression models, unadjusted and adjusted for symptoms and other known predictors of colorectal cancer.

Question reliability was assessed in a different sample using percentage agreement and the kappa statistic for the answers given by each patient on two occasions. Agreement between patient and doctor responses was also assessed (n = 108).


Patients who reported they took symptoms less seriously were 3.28 (95%CI: 2.02, 5.33) times more likely to have colorectal cancer than patients who took symptoms more seriously than others. The effect was smaller (1.85 (95%CI: 1.11, 3.09)), but remained statistically significant in models including symptoms and other predictors of colorectal cancer. The question was reliable: on repeat questioning, 70% of responses were in absolute agreement and 92% were within 1 category, kappa 57%. Patient-doctor agreement was 66%, within 1 category 92%, kappa 48%.


Patients who take their symptoms less seriously have a considerably higher likelihood of colorectal cancer than those who identify themselves as taking any symptoms more seriously than other people. The question is easy to ask and has good reliability. Doctors also reliably identify how patients assess themselves. Assessment of how seriously patients take any symptoms can contribute to the clinical assessment of a patient.

Symptom perception; Colorectal cancer; Questionnaire; Reliability; Predictive value of tests