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Aims Patients with rectal cancers would be expected to be symptomatic and present to GP and be referred to tertiary care for investigations. Nevertheless nearly 15% of rectal cancers are screen detected. This study compared the presentation, demographics, staging of screen detected rectal cancer (SDRC) and symptomatic rectal cancer (SRC). Methods The national bowel cancer-screening database, the Somerset Cancer Register, the Great North Record, hospital electronic patient record and Sunquest ICE system was used to gather clinical information. All rectal cancers diagnosed between 2014 and 2019 were included. Results There were 379 SRC and 54 SDRC. The SRC had an average of 1.07 GP visits per patient (range 1-4) and SDRC had an average of 0.27 GP visits per patient (range 0-7) (p &amp;lt; 0.001). Screen detected patients presented to their GP with diarrhoea, change of bowel habit and bleeding whereas symptomatic patients presented with tenesmus, bleeding and change of bowel habit in that order respectively. Screening cancers were more likely to present as T1 or T2 compared to the symptomatic group (p = 0.023). Conclusion Screen detected rectal cancer patients presented less frequently to their GP. Those who presented had a different symptom profile to symptomatic cancers. This would explain these patients not seeking advice or the GP not referring them to hospital. Is it the morphological differences of the cancers or is it that the patients in screening group have a different personality trait that prevents them consulting their GP. These questions need investigating in future studies.

SP1.2.8Are screen detected rectal cancers truely asymptomatic?