A positive diagnosis of irritable bowel syndrome does not give immunity from developing bowel cancer

The phrase ‘in the absence of alarm features’ is used in the introduction and conclusion of Sood et al’s article,¹ but there is no discussion of what might constitute an alarm feature. I am an elderly retired GP. My wife has had and her mother had, intermittently for many years, symptoms of irritable bowel syndrome (IBS). My mother-in-law later developed additional symptoms that caused her GP to refer her to a gastroenterologist for further investigation three times. The first two times the additional symptoms were dismissed as a flare-up of the IBS with minimal investigation; the third time a diagnosis of inoperable bowel cancer was made. A positive diagnosis of IBS does not give immunity from developing additional conditions.