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This study aims to assess the extent to which different referral pathways following a diagnosis of iron deficienct anaemia (IDA) are associated with delays to the diagnosis of colorectal cancer (CRC). The impact of NICE guidelines on the time taken to CRC diagnosis was also assessed.A retrospective cohort study was carried out onprospectively collected data. Patients aged 40 years or over, with IDA diagnosed inprimary care and subsequent diagnosis of CRC between 1st January 2000 and 31st December 2006 were included. The time taken from IDA to CRC diagnosis following the introduction of NICE guidelines were assessed.Six lakhs twenty eight thousand and eight hundred and eighty-two eligible patients were identified from 170 generalpractices. A total of 578 patients (0.1%) with IDA subsequently were diagnosed with colorectal cancer. The median time to CRC diagnosis ranged from 0.16 to 2.53 years. Time to diagnosis was significantly longer in patients referred to medical specialties when compared to relevant surgical specialties (P = 0.0006). There was no significant improvement in the time to CRC diagnosis after the introduction of the NICE guidelines.This study has demonstrated significant differences in the time taken to CRC diagnosis following aprimary care diagnosis of IDA between referred specialties. The introduction of NICE guidelines does not appear to have reduced diagnostic delay.