Greater Risk Of Colorectal Cancer Research Articles

Risk of colorectal cancer associated with frequency of colorectal polyp diagnosis in relatives.

We aimed to evaluate the association of frequency of polyp diagnosis in relatives with the risk of overall and early-onset colorectal cancer (CRC). We leveraged data from nationwide Swedish family cancer datasets (1964-2018) to calculate standardized incidence ratios (SIRs) for individuals with a family history of polyp by frequency of polyp diagnosis in family members. We followed up 11,676,043 individuals for up to 54 years. Compared with the risk in individuals without a family history of colorectal tumor (N=142,234), the risk of overall CRC was 1.4-fold in those with 1 FDR with one-time polyp diagnosis [95%CI=1.3-1.4, N=11,035; early-onset SIR: 1.4 (1.3-1.5), N=742]. The risk was significantly higher in individuals with 1 FDR with ≥2 times (frequent) polyp diagnoses [overall CRC: 1.8 (1.8-1.9); early-onset CRC=2.3 (2.0-2.6)]. A rather similar risk was observed for individuals with ≥2 FDRs with one-time polyp diagnosis [overall CRC: 1.9 (1.7-2.1); early-onset CRC: 2.2 (1.5-2.9)]. Individuals with ≥2 FDRs with frequent polyp diagnoses had a 2.4-fold overall risk (2.2-2.7) and a 3.9-fold early-onset risk (2.8-5.3). Younger age at polyp diagnosis in FDRs was associated with an increased risk of CRC. A family history of polyp in second-degree relatives was important only when there were frequent diagnoses of polyp. A higher frequency of colorectal polyp diagnosis in relatives is associated with a greater risk of CRC, especially early-onset CRC. This risk is independent of number of affected relatives or youngest age at polyp diagnosis. These findings underscore the need for more personalized CRC screening strategies that are tailored to individuals with a family history of polyp.

A Case-Control Study of Dietary Choline Intake and Risk of Colorectal Cancer Modified by Dietary B-Vitamin Intake.

The incidence of colorectal cancer (CRC) is rising, and Western diets high in red and processed meats may be contributing. It is important to identify dietary nutrients that increase CRC risk and perhaps interventions that may modulate such risk. The relationship between dietary choline intake and CRC is still unclear. We hypothesize that high dietary choline intake is associated with greater CRC risk, and B vitamin supplementation may modify this risk. In this case-control study, we collected demographic and dietary data using the validated National Cancer Institute CRC Risk Assessment Tool and Dietary Health Questionnaire III and analyzed colonoscopy outcomes. Logistic regression and stratified analyses were performed to calculate adjusted odds ratios and evaluate for effect modification. Of 52 total patients, 21 had a normal colonoscopy result, and 31 were found to either have benign polyps or CRC. The average dietary choline intake was 207 mg/day in the normal group and 297 mg/day in the abnormal outcome group. A doubling in dietary choline intake was significantly associated with increased odds of polyps or CRC (OR 25.32, 95% CI 1.95-327.94). When stratified by vitamin B levels, the effect modification was difficult to confidently quantify due to the limited sample size. Our findings suggest that higher dietary choline intake may be associated with an increased risk of CRC and its precursors, such as polyps. Although the potential modifying role of B vitamins was inconclusive, this study underscores the need for larger-scale research to further explore these associations and to assess the potential of dietary interventions in reducing CRC risk.

Higher frequency of fruit and vegetable consumption is associated with greater daily stool weight in adults with constipation

This abstract was presented as the Nutrition in the Treatment, Management and Prevention of Disease Theme Highlight.Chronic constipation is a prevalent gastrointestinal condition affecting approximately 10% of the global population(1) and is associated with substantial healthcare costs and quality of life impairments in the UK(2). While the aetiology of chronic constipation is not fully understood, lower dietary fibre intake is associated with greater risk of constipation(3) and consumption of fruits, vegetables, and wholegrains is recommended within clinical guidelines. Although not diagnostic for constipation, low stool weight is a common feature and is associated with greater risk of colorectal cancer(4); yet few studies have ever measured stool weight in constipation. This study investigated associations between frequency of plant food intake and stool weight in people with constipation.Baseline data from a dietary intervention trial were analysed, which included participants meeting Rome IV criteria for constipation. Self-reported data on habitual consumption of nine plant food categories were collected using a validated tool. Participants performed 7-day total stool collection, which was weighed on the same weighing scales at the research centre. Associations between intake frequency for each plant food category and daily stool weight (total stool weight divided by 7 days) were analysed using independent-samples t-tests (SPSS, version 28, p<0.05 considered significant).Ninety-nine people with Rome IV constipation (89% female; mean [ ± SD] age 32.4 [ ± 12.4] y; BMI 23.0 [ ± 3.2] kg/m2) provided 7-day total stool collections. Mean ( ± SD) stool weight was 72.5 ± 47.2 g/day (minimum 2.1 g/day; maximum 280.6 g/day). Stool weight was significantly higher among those consuming fruit once or more per day (86.2 ± 48.2 g/day), compared with those consuming fruit less than once per day (62.4 ± 44.1 g/day; p = 0.012). Stool weight was also higher among those consuming vegetables once or more per day (98.6 ± 59.1 g/day) compared with those eating vegetables less than once per day (62.2 ± 37.2 g/day; p<0.001). Differences for green salad (79.6 ± 52.1 g/day; 63.3 ± 38.5 g/day; p = 0.088) and high-fibre breads (84.1 ± 46.6 g/day; 65.1 ± 46.6 g/day; p = 0.05) were borderline significant, when comparing those consuming these more than once per week, compared with once or less per week (respectively). No significant differences were found for frequency of consuming fruit juices, potatoes, vegetable soups/stews, high-fibre cereals, or beans and lentils.This is the most comprehensive analysis to date of measured stool weight in constipation, and its association with plant food intake. Despite presence of constipation, participants with higher intakes of fruit and vegetables had a greater daily stool weight; an important feature associated with lower colorectal cancer risk(4). However, intakes were not sufficient to manage their constipation symptoms. Intervention studies investigating potential benefits from increasing fruit and vegetable intakes in people with constipation are required and are currently underway.

Association between sulfur microbial diet and the risk of colorectal cancer precursors in older adults.

Sulfur microbial diet (SMD), related to the enrichment of sulfur-metabolizing gut bacteria, has been confirmed to be linked to an elevated risk of early-onset colorectal adenoma in young females. However, it remains unclear whether SMD is associated with the risk of colorectal adenoma in older people, who are at greater risk for colorectal cancer. All data on participants in this study were retrieved from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening test. Participants' adherence to this dietary pattern was assessed using SMD score. Hazard ratios (HR) and 95% confidence intervals (CI) were adopted in Cox proportional hazards regression models to assess the link between SMD score and the incidence of colorectal adenoma in participants included in the study. Specific stratified analyses were constructed to assess whether this association changed in different conditions, whereas the robustness of the association was examined through sensitivity analyses. The mean baseline age of participants was 62.1 (SD 5.2) years (range 54.0-75.0 years). During 19,468,589 person-years of follow-up, 992 colorectal adenoma cases were documented in a total of 17,627 included participants. In a fully adjusted model, an increased risk of colorectal adenoma was determined in participants in the highest quartile of SMD score in comparison with those in the lowest quartile (HRquartile4 vs. HRquartile1 = 1.23; 95% CI: 1.02, 1.47; p = 0.017 for trend). This positive association between SMD score and adenoma risk was more evident in participants who were current or former smokers (p = 0.029 for interaction). In this study, our results support a role for the SMD in the carcinogenicity of colorectal cancer precursors among older adults. Nevertheless, these results require validation through more research.

Saturated fatty acid intake, genetic risk and colorectal cancer incidence: A large-scale prospective cohort study.

Previous investigations mainly focused on the associations of dietary fatty acids with colorectal cancer (CRC) risk, which ignored gene-environment interaction and mechanisms interpretation. We conducted a case-control study (751 cases and 3058 controls) and a prospective cohort study (125 021 participants) to explore the associations between dietary fatty acids, genetic risks, and CRC. Results showed that high intake of saturated fatty acid (SFA) was associated with a higher risk of CRC than low SFA intake (HR =1.22, 95% CI:1.02-1.46). Participants at high genetic risk had a greater risk of CRC with the HR of 2.48 (2.11-2.91) than those at low genetic risk. A multiplicative interaction of genetic risk and SFA intake with incident CRC risk was found (PInteraction = 7.59 × 10-20 ), demonstrating that participants with high genetic risk and high SFA intake had a 3.75-fold greater risk of CRC than those with low genetic risk and low SFA intake. Furthermore, incorporating PRS and SFA into traditional clinical risk factors improved the discriminatory accuracy for CRC risk stratification (AUC from 0.706 to 0.731). Multi-omics data showed that exposure to SFA-rich high-fat dietary (HFD) can responsively induce epigenome reprogramming of some oncogenes and pathological activation of fatty acid metabolism pathway, which may contribute to CRC development through changes in gut microbiomes, metabolites, and tumor-infiltrating immune cells. These findings suggest that individuals with high genetic risk of CRC may benefit from reducing SFA intake. The incorporation of SFA intake and PRS into traditional clinical risk factors will help improve high-risk sub-populations in individualized CRC prevention.

Association between metabolic syndrome and colorectal cancer incidence and all-cause mortality: a hospital-based observational study

BackgroundMetabolic syndrome (MetS) is a worldwide pandemic and complex disorder associated with colorectal cancer (CRC). This study aims to identify the influence of number of MetS components on CRC incidence and mortality, using a national, longitudinal dataset of hospital care in Taiwan.MethodsPatient data from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2008 were extracted. Individuals with at least one inpatient diagnosis or 2 outpatient visits with any MetS component found within one year were identified and included. Subjects died within 12 months after the presence of MetS components or had any prior cancer were excluded. The study cohort were then divided into two groups: subjects who had more (i.e., 3 to 4) MetS components and those who had fewer (i.e., 1 to 2) MetS components. An 2:1 propensity score (PS) matching were performed to balance the baseline characteristics between the groups. Cox regression analyses were conducted to compare the CRC incidence and all-cause mortality at follow-up between subjects with more MetS components versus fewer components.ResultsAfter matching, a total of 119,843 subjects (78,274 with 1–2 and 41,569 with 3–4 MetS components) were analyzed. After adjusting for confounders, subjects with 3–4 MetS components had a significantly higher risk of CRC [adjusted hazard ratio (aHR), 1.28; 95% confidence interval (CI), 1.15–1.43, p < 0.001) and all-cause mortality (aHR, 1.13; 95% CI, 1.08–1.17, p < 0.001) than those with only 1–2 MetS components. In stratified analyses, the greatest increased risk of CRC incidence that 3–4 MetS components posed as compared to 1–2 MetS components was seen in subjects without CHD history (aHR, 1.41, 95% CI, 1.23–1.62, p < 0.001). In addition, 3–4 MetS components (vs. 1–2) led to greater all-cause mortality among the subjects < 65y, both genders, with or without CHD, subjects without CKD hisotry, both aspirin users and non-users, users of nonsteroidal anti-inflammatory drugs (NSAIDs), and users of statin.ConclusionCompared with 1–2 components, subjects with 3–4 MetS components are at greater risk of CRC and death at follow-up. This study also demonstrates the risks for CRC and all-cause mortality in certain subgroups of individuals with 3–4 MetS components compared to 1–2 components. These findings may help clinicians on the CRC risk stratification according to individuals’ characteristics, as well as to optimize the strategy of MetS surveillance and control in order to prevent CRC.

Associations between serum vitamin D biomarkers and tumor expression of Ki67, p53, and COX-2 in colorectal cancer cases from the Southern Community Cohort Study

Higher 25-hydroxyvitamin D is associated with lower colorectal cancer (CRC) risk, with limited data from African Americans (AAs), who have greater risk for CRC and 25-hydroxyvitamin D deficiency. In a predominantly AA sample of CRC cases from the Southern Community Cohort Study (SCCS), we report associations between vitamin D biomarkers and tumor expression of proteins implicated in vitamin D’s anti-tumorigenic pathways (e.g. proliferation and inflammation) and CRC prognosis. SCCS participants with incident CRC were identified via state cancer registries. Serum 25-hydroxyvitamin D and vitamin D binding protein (VDBP) were measured at enrollment. ‘Free’ 25-hydroxyvitamin D was calculated via standard equation. Cellular Ki67, p53, and COX-2 were measured from tumor samples and categorized using literature-defined cut-points related to survival. Generalized linear models were used to measure associations between vitamin D exposures, tumor biomarkers, and stage. In total, 104 cases (40–79 years) were analyzed. 25-hydroxyvitamin D was not associated with high Ki67 (odds ratio (OR) per 1-standard deviation (SD) increase [95% confidence interval] 1.35[0.86–2.11]), p53 (0.75[0.47–1.20]), or COX-2 expression (1.25[0.78–2.01]), or metastatic disease (1.04[0.59–1.81]). Mean biomarker expression was unrelated to 25-hydroxyvitamin D (p-trend ≥.09). Null associations were observed for VDBP and free 25-hydroxyvitamin D. In AAs (n = 70), higher VDBP was associated with lower odds of high Ki67 expression (0.53[0.28–0.98], p-trend =.04). In conclusion, we observed no associations between 25-hydroxyvitamin D and prognostic marker expression in CRC. An inverse association between VDBP and tumor Ki67 in AAs is consistent with reports showing relationships with reduced CRC mortality.

Solid extraintestinal malignancies in patients with inflammatory bowel disease.

Malignancies constitute the second cause of death in patients with inflammatory bowel diseases (IBD), after cardiovascular diseases. Although it has been postulated that IBD patients are at greater risk of colorectal cancer compared to the general population, lately there has been evidence supporting that this risk is diminishing over time as a result of better surveillance, while the incidence of extraintestinal cancers (EICs) is increasing. This could be attributed either to systemic inflammation caused by IBD or to long-lasting immunosuppression due to IBD treatments. It seems that the overall risk of EICs is higher for Crohn’s disease patients and it is mainly driven by skin cancers, and liver-biliary cancers in patients with IBD and primary sclerosing cholangitis. The aims of this review were first to evaluate the prevalence, characteristics, and risk factors of EICs in patients with IBD and second to raise awareness regarding a proper surveillance program resulting in early diagnosis, better prognosis and survival, especially in the era of new IBD treatments that are on the way.

Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies.

Red meat and processed meat consumption has been hypothesized to increase risk of cancer, but the evidence is inconsistent. We performed a systematic review and meta-analysis of prospective studies to summarize the evidence of associations between consumption of red meat (unprocessed), processed meat, and total red and processed meat with the incidence of various cancer types. We searched in MEDLINE and EMBASE databases through December 2020. Using a random-effect meta-analysis, we calculated the pooled relative risk (RR) and 95% confidence intervals (CI) of the highest versus the lowest category of red meat, processed meat, and total red and processed meat consumption in relation to incidence of various cancers. We identified 148 published articles. Red meat consumption was significantly associated with greater risk of breast cancer (RR = 1.09; 95% CI = 1.03-1.15), endometrial cancer (RR = 1.25; 95% CI =1.01-1.56),colorectal cancer (RR = 1.10; 95% CI = 1.03-1.17), colon cancer(RR = 1.17; 95% CI = 1.09-1.25), rectal cancer (RR = 1.22; 95% CI = 1.01-1.46),lung cancer(RR = 1.26; 95% CI = 1.09-1.44), and hepatocellular carcinoma (RR = 1.22; 95% CI = 1.01-1.46). Processed meat consumption was significantly associated with a 6% greater breast cancer risk, an 18% greater colorectal cancer risk, a 21% greater colon cancer risk,a 22% greater rectal cancer risk, and a 12% greater lung cancer risk. Total red and processed meat consumption was significantly associated with greater risk of colorectalcancer (RR = 1.17; 95% CI = 1.08-1.26), coloncancer (RR = 1.21; 95% CI = 1.09-1.34), rectal cancer(RR = 1.26; 95% CI = 1.09-1.45), lung cancer(RR = 1.20; 95% CI = 1.09-1.33), and renal cell cancer (RR = 1.19; 95% CI = 1.04-1.37). This comprehensive systematic review and meta-analysis study showed that high red meat intake was positivelyassociated with risk of breast cancer, endometrial cancer,colorectal cancer, colon cancer, rectal cancer, lung cancer, and hepatocellular carcinoma, and high processed meat intake was positivelyassociated with risk of breast, colorectal, colon,rectal, and lung cancers. Higher risk of colorectal, colon, rectal, lung, and renal cell cancers were also observed with high total red and processed meat consumption.

Prioritisation of lower gastrointestinal endoscopy during the COVID-19 pandemic: outcomes of a novel triage pathway

ObjectiveThe 2-week-wait (2ww) referral pathway is used in England to fast-track patients with suspected colorectal cancer (CRC). A two-stage triage pathway was used to prioritise lower gastrointestinal (LGI) endoscopy for...

Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women

Although colorectal cancer (CRC) incidence in the USA is declining overall, its incidence is increasing among those younger than 50 years of age. The reasons underlying the increasing trend are largely unknown, although behavioral changes, such as unhealthy diet and lifestyle factors, may be partially responsible. A prospective cohort study included 94217 women aged 26-45 years at baseline. Validated anthropometric measures and lifestyle information were self-reported biennially. Exposures were four recommendation-based dietary indices-the prime diet quality score and three plant-based dietary indices; and two mechanism-based indices-the empirical dietary and lifestyle index for hyperinsulinemia (EDIH and ELIH). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall CRC and for early-onset (before age 50) and after age 50 CRC separately. We documented 332 cases of CRC during 24 years of follow-up (2113655 person-years), with an average age of 52 ± 7 years at diagnosis. Hyperinsulinemic dietary and lifestyle patterns were associated with a higher risk of CRC. Multivariable-adjusted HRs (95% CIs) comparing participants in the highest versus lowest quartile were: 1.67 for EDIH (95% CI: 1.15-2.44, P-trend= 0.01) and 1.51 for ELIH (95% CI: 1.10-2.08, P-trend= 0.01). Moreover, per 75% increment in rank, ELIH appeared to be a stronger risk factor for early-onset CRC (HR= 1.86, 95% CI: 1.12-3.07) than after age 50 CRC (HR= 1.20, 95% CI: 0.83-1.73, P-heterogeneity= 0.16). The four recommendation-based indices were not significantly associated with overall, early-onset, or after age 50 CRC risk (per 75% increment in rank, HRs ranged from 0.75 to 1.28). Dietary and lifestyle patterns contributing to hyperinsulinemia were associated with greater CRC risk in younger women. Moreover, the hyperinsulinemic lifestyle showed a suggestively stronger positive association with early-onset CRC risk, compared with after age 50 CRC. Our findings suggest that dietary and lifestyle interventions to reduce insulinemic potential may be effective for CRC prevention among younger women.

Sugary Drink Consumption and Subsequent Colorectal Cancer Risk: The Japan Public Health Center-Based Prospective Cohort Study.

Most studies examining the associations of sugary drink consumption on colorectal cancer risk have been conducted in Western populations. This study consisted of 74,070 participants in the Japan Public Health Center-based Prospective Study who completed a food frequency questionnaire (1995-1999). The participants were followed until December 2013 to investigate the associations between sugary drink consumption and colorectal cancer risk using Cox proportional hazards regression models. Among the 74,070 participants, mean age was 56.5 years at baseline, with a mean body mass index (BMI) of 23.5 and a mean daily consumption of 286 mL/day for men and 145 mL/day for women. During a follow-up of 15 years, 1,648 colorectal cancer cases were identified. No overall greater risk of colorectal cancer was observed among men [multivariable HR = 0.84; 95% confidence of interval (CI), 0.70-1.02; ≥254 mL/day vs. nonconsumers] and women (HR = 1.20; 95% CI, 0.96-1.50, ≥134 mL/day vs. nonconsumers). Sugary drink consumption was associated with colon cancer among women (HR = 1.36; 95% CI, 1.03-1.78, ≥134 mL/day vs. nonconsumers). HRs for proximal colon cancer among women who consumed sugary drinks, as compared with nonconsumers, were 1.47 (95% CI, 1.03-2.10) for sugary drink consumption less than 134 mL/day, and 1.45 (95% CI, 1.01-2.09) for at least 134 mL/day. In this large prospective cohort of Japanese with a moderate sugary drink consumption level and low prevalence of obesity, we observed a 36% increased risk of colon cancer in women. Our findings highlight the importance of subsite- and sex-specific investigation.

Should colorectal cancer screening start at different ages for men and women? Cost-effectiveness analysis for a resource-constrained service.

BackgroundMen have a greater risk of colorectal cancer (CRC) than women, but population screening currently starts at the same age for both sexes.AimThis analysis investigates whether, in a resource‐constrained setting, it would be more effective and cost‐effective for men and women to start screening for CRC at different ages.Methods and resultsAn economic modeling analysis was carried out using the Microsimulation Model in Cancer of the Bowel to compare sex‐stratification against screening everyone from the same age, taking an English National Health Service perspective. Screening men from age 56 and women from age 60, rather than screening everyone from age 58 using a Fecal Immunochemical Test (FIT) threshold of 120 μg/g is expected to produce an additional 0.0004 QALYs for a cost of £0.55 per person at model start (Incremental Cost‐effectiveness Ratio = £1392), and to reduce CRC cases and mortality by 25 and 19 per 100 000 people respectively, while using a similar amount of screening resources. Probabilistic sensitivity analysis indicates a 61% probability that sex‐stratification is more cost‐effective than screening everyone at age 58. Similar benefits of sex‐stratification are found at other FIT thresholds, but become negligible if mean screening start age is reduced to 50.ConclusionWhere resources are constrained and it is not feasible to screen everyone from the age of 50, starting screening earlier in men than women is likely to be more cost‐effective and gain more health benefits overall than strategies where men and women start screening at the same age.

Vitamin D Receptor (VDR) Gene Polymorphism in Patients Diagnosed with Colorectal Cancer.

Colorectal cancer (CRC) is one of the most commonly occurring neoplasias in humans. The prevalence of CRC rates is still rising. Although the exact background of the disease still remains unknown, it is believed that CRC may not only be a result of environmental factors, but also genetic ones. One of the mechanisms underlying CRC might be the vitamin D pathway, as CRC is the most closely linked neoplasia to vitamin D deficiency. This study shows a possible association of the vitamin D receptor (VDR) polymorphisms FokI, BsmI, ApaI, and TaqI with CRC susceptibility. A total of 103 patients diagnosed with CRC (61 men and 42 women, aged 57–82 years) and 109 healthy people (50 men and 59 women, aged 47–68 years) were genotyped using PCR-RFLP for FokI, BsmI, ApaI, and TaqI. None of the single nucleotide polymorphisms (SNPs) individually increased or decreased the risk of CRC. The evaluation of haplotypes revealed two that might enhance the likelihood of CRC development: taB (OR = 30.22; 95% CI 2.81–325.31; p = 0.01) and tAb (OR = 3.84; 95% CI 1.29–11.38; p = 0.01). In conclusion, genotyping is an easy and robust procedure that needs to be performed only once in a lifetime. A creation of a relevant SNP’s panel might contribute to the identification of the groups that are at the greatest risk of CRC.

Nitrate-nitrite exposure through drinking water and diet and risk of colorectal cancer: A systematic review and meta-analysis of observational studies

Considerable controversy exists regarding the association between nitrate intake and risk of colorectal cancer. Therefore, we performed a dose-response meta-analysis of observational studies. We identified relevant studies by searching PubMed, Scopus and ISI Web of Knowledge until April 2020 and references of retrieved relevant articles. The random-effects model was used to calculate pooled effect size (ESs) and 95% confidence intervals (CIs). Fifteen prospective cohort and case-control papers were included in this systematic review and meta-analysis. In total, 2,573,524 participants with an age range between 20 and 85 years were included. The total number of colorectal cancer cases was 38,848. Intake of nitrate from diet was associated with a risk of colorectal cancer (Pooled HR: 1.13; 95% CI: 1.04-1.23, I2=38%; P=0.08). Nitrite in diet was not significantly associated with risk of colorectal cancer (pooled HR: 1.07; 95% CI: 0.95-1.21, I2=61.6%; P=0.005). Nitrate in water did not show an association with risk of colorectal cancer (pooled HR: 1.04; 95% CI: 0.92-1.19, I2=64.7%; P=0.002). Non-linear dose-response analysis revealed no significant association of dietary nitrite and also nitrate of drinking water with risk of colorectal cancer. However, dietary nitrate was marginally associated with a greater risk of colorectal cancer. Linear dose-response analysis of nitrate from diet was not associated with colorectal cancer risk by an additional 50mg per day. Such a non-significant association was also seen for colorectal cancer risk by an additional 1mg per day and 1mg/l from dietary nitrite and water nitrate respectively. Dietary nitrate was related to a higher risk of colorectal cancer risk. However, intake of nitrite from diet and nitrate from the drinking water was not associated with colorectal cancer risk.

A patient with colitis-associated cancer who developed clinically manifest Crohn\u2019s disease only after surgery

BackgroundPatients with prolonged inflammatory bowel disease have a greater risk of colorectal cancer, known as colitis-associated cancer. Here we describe an unusual case of colitis-associated cancer.Case presentationThe subject is a 41-year-old male who has not presented digestive symptoms and has an appreciable medical history. He consulted a nearby doctor with left flank pain. A colonoscopy revealed a lateral spreading tumor (granular-type) in his descending colon. With a clinical diagnosis of cancer, D3 left hemicolectomy was performed and a small intestine stoma was constructed. The pathological diagnosis of the tumor was mucinous adenocarcinoma, pT4a(SE), pN2a, which was associated with dysplasia in the surface area. Post-operative ileus was prolonged and the endoscopic examination revealed longitudinal ulcers in the ileum. These ulcers responded quite well to the administration of infliximab, confirming the final diagnosis of Crohn’s disease. Pathological re-examination revealed that the tumor was dysplasia-associated type, and another dysplasia was confirmed near the tumor. Furthermore, mural scars and sporadic lymphoid aggregates were noted in the colon tissues, which suggested pre-existing Crohn’s disease. The patient died of peritoneal dissemination of cancer on day 207 after surgery.ConclusionThe present case was diagnosed as colitis-associated cancer with clinically latent Crohn’s disease, who developed clinically manifest Crohn’s disease only after surgery. Our review of literature revealed no cases comparable to ours.

The use of electronic healthcare records for colorectal cancer screening referral decisions and risk prediction model development

BackgroundThe database used for the NHS Bowel Cancer Screening Programme (BCSP) derives participant information from primary care records. Combining predictors with FOBTs has shown to improve referral decisions and accuracy. The richer data available from GP databases could be used to complement screening referral decisions by identifying those at greatest risk of colorectal cancer. We determined the availability of data for key predictors and whether this information could be used to inform more accurate screening referral decisions.MethodsAn English BCSP cohort was derived using the electronic notifications received from the BCSP database to GP records. The cohort covered a period between 13th May 2009 to 17th January 2017. Completeness of variables and univariable associations were assessed. Risk prediction models were developed using Cox regression and multivariable fractional polynomials with backwards elimination. Optimism adjusted performance metrics were reported. The sensitivity and specificity of a combined approach using the negative FOBT model plus FOBT positive patients was determined using a probability equivalent to a 3% PPV NICE guidelines level.Results292,059 participants aged 60–74 were derived for the BCSP screening cohort. A model including the screening test result had a C-statistic of 0.860, c-slope of 0.997, and R2 of 0.597. A model developed for negative screening results only had a C-statistic of 0.597, c-slope of 0.940, and R2 of 0.062. Risk predictors included in the models included; age, sex, alcohol consumption, IBS diagnosis, family history of gastrointestinal cancer, smoking status, previous negatives and whether a GP had ordered a blood test. For the combined screening approach, sensitivity increased slightly from 53.90% (FOBT only) to 58.82% but at the expense of an increased referral rate.ConclusionsThis research has identified several potential predictors for CRC in a BCSP population. A risk prediction model developed for BCSP FOBT negative patients was not clinically useful due to a low sensitivity and increased referral rate. The predictors identified in this study should be investigated in a refined algorithm combining the quantitative FIT result. Combining data from multiple sources enables fuller patient profiles using the primary care and screening database interface.

Clinicopathological features of colorectal polyps and risk of colorectal cancer in acromegaly.

Patients with acromegaly are at increased risk of colorectal polyps. However, their risk of colorectal cancer remains unclear. This study aimed to identify the histopathological features of colorectal polyps in patients with acromegaly and compare their risk of colorectal cancer with that in healthy controls. The study participants were 178 patients who underwent Hardy's operation and perioperative colonoscopy at our hospital between April 2008 and September 2016. For the control group, we randomly selected 356 age- and sex-matched patients who underwent colonoscopy at our hospital during the same period. The incidence, size, location, and histology of the colorectal polyps detected were compared between the groups. Colorectal polyps were detected in 66.8% of the acromegaly group and 24.2% of the control group (P < 0.001). The average number and size of the polyps were 2.44 and 4.74 mm, respectively, in the acromegaly group and 1.77 and 3.89 mm in the control group (P = 0.001). Polyps in the acromegaly group were more likely to be in the rectosigmoid region (P = 0.006). In the acromegaly group, the frequency of polyps ≥5 mm was 34.3% and that for polyps ≥10 mm was 15.2%; the respective values were 7.6% and 2.2% in the control group (P < 0.001). We found no evidence of between-group histopathological differences in the polyp specimens resected by endoscopy. Patients with acromegaly are at an increased risk of colorectal polyps, especially in the rectosigmoid region. However, there is no pathological evidence that they are at greater risk of colorectal cancer than the general population.

Prevalence and Risk Factors of Gastric and Colorectal Cancer after Cholecystectomy.

BackgroundPrevious studies on the relationship between gastrointestinal (GI) cancer and cholecystectomy remain inconclusive. We aimed to evaluate this relationship, albeit particularly between cholecystectomy and gastric cancer or colorectal cancer (CRC), and the risk factors of cancer among individuals who have undergone cholecystectomy in Korea.MethodsIn total, 4,222 patients who underwent laparoscopic or open cholecystectomy at our institution between January 2006 and December 2013 were included. Patients who underwent cholecystectomy for gallbladder cancer or were undergoing surgery for GI, hepatic, or pancreatobiliary cancers were excluded, as were those who developed stomach cancer or CRC within a year of their cholecystectomy. The included patients were followed until July 20, 2020. The standardized incidence ratio (SIR) was used to calculate the relative risk of GI cancer in cholecystectomy patients.ResultsThe median patient age (n = 3,588) at the time of cholecystectomy was 54.0 (range, 19–95) years, and the male-to-female ratio was 1:1.04. The median follow-up period after cholecystectomy was 15.0 (range, 0–146) months. We found a 108% greater risk of CRC (SIR, 2.08; 95% confidence interval [CI], 1.28–3.17) and 154% increased risk of CRC in females (SIR, 2.54; 95% CI, 1.16–4.84). Based on multivariate analysis, an age of > 60 years was a significant risk factor for GI cancer in cholecystectomy patients.ConclusionCholecystectomy may increase risk of CRC, especially in females. Age was considered a risk factor of GI cancers in patients with history of cholecystectomy.

Angiopoietin-2 gene polymorphisms are biomarkers for the development and progression of colorectal cancer in Han Chinese.

Colorectal cancer (CRC) is one of the most common cancers in Han Chinese and is characterized by low rates of early diagnosis and poor survival rates. Angiopoietin-2 (Ang2), an endothelial tyrosine kinase, is involved in CRC progression, but little is known about the association between single nucleotide polymorphisms (SNPs) and diagnosis or prognosis of CRC. This study reports on the association between 5 SNPs of the Angpt2 gene (rs2442598, rs734701, rs1823375, 11137037, and rs12674822) and CRC susceptibility as well as clinical outcomes in 379 patients with CRC and in 1,043 cancer-free healthy controls. Carriers of the CG allele at rs1823375 and those with the GT+TT allele of the variant rs12674822 were at greater risk of CRC than their respective wild-type counterparts. Moreover, carriers of the GT or GT+TT allele in rs12674822 were significantly more likely to have tumor involvement in both the colon and rectum compared with wild-type (GG) carriers, while 5-year progression-free survival was also significantly worse in those carrying the GT+TT allele in rs12674822 compared with wild-type carriers. Our study is the first to describe correlations between Angpt2 polymorphisms and CRC development and progression in people of Chinese Han ethnicity.