Colorectal Cancer Risk in Patients with Hemorrhoids: A 10-Year Population-Based Retrospective Cohort Study.

Fung-Chang Sung,En-Bo Wu,Kuen-Bao Chen,Cheng-Li Lin,Kuen-Lin Wu

doi:10.3390/ijerph18168655

Abstract

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan’s National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78–2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48–3.28) and 1.79 (95% CI = 1.06–3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.

Highlights

Licensee MDPI, Basel, Switzerland.Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide
These propensity-score-matched study cohorts were similar in prevalence rates of most comorbidities, except that the rates of hypertension, diabetes, and congestive heart failure were higher in the hemorrhoid cohort than in the comparison cohort (Table 1)
More than half of the study population were men and there were more in the hemorrhoid cohort than there were in the comparison cohort

Summary

Introduction

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. Both genetic and environmental factors are associated with the risk of developing CRC. The consumption of red meat, lack of physical activity, obesity, cigarette smoking, and alcohol use are known risk factors of CRC [1]. Most CRCs arise from adenomas that progress to dysplasia and carcinoma. The progression from adenoma to adenocarcinoma takes 10 years [2]. Neoplastic changes result from both inherited and published maps and institutional affil-

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