Colorectal Cancer Hazard Ratio Research Articles

Association Between Visceral Fat Area and Cancer Prognosis: A Population-Based Multicenter Prospective Study

BackgroundDiverse indicators have been used to represent adipose tissue, while the relationship between body adipose mass and the prognosis of patients with cancer remains controversial. ObjectiveThis study aimed to explore the indicators of optimal body composition that represent body fat mass to predict risk of cancer-related mortality. MethodsWe conducted a population-based multicenter prospective cohort study of patients with initial cancer between February 2012 and September 2020. Clinical information, body composition indicators, hematologic test results, and follow-up data were collected. Body composition indicators were analyzed using principal component analysis to select the most representative indicators, and the cutoff value was set according to the optimal stratification method. The hazard ratio (HR) for mortality was calculated using Cox proportional hazards regression models. ResultsAmong 14,018 patients with complete body composition data, visceral fat area (VFA) is a more optimal indicator for body fat content (principal component index: 0.961) than body mass index (principal component index: 0.850). The cutoff points for VFA in terms of time to mortality were 66 cm2 and 102 cm2 for gastric/esophageal cancer and other cancers, respectively. Among the 2788 patients treated systemically, multivariate analyses demonstrated that a lower VFA was associated with a higher risk of death in patients with cancer of diverse types (HR: 1.33; 95% CI: 1.08, 1.64; P = 0.007), especially gastric cancer (HR: 2.13; 95% CI: 1.3, 3.49; P = 0.003), colorectal cancer HR: 1.81; 95% CI: 1.06, 3.08; P = 0.030) and nonsmall-cell lung cancer (HR: 1.27; 95% CI: 1.01, 1.59; P = 0.040). ConclusionVFA is an independent prognostic indicator of muscle mass in patients with diverse types of cancer, particularly gastric, colorectal, and nonsmall-cell lung cancers. Trial registration numberChiCTR1800020329.

1519. Increased incidence of colorectal cancer in Veteran Health Administration hospital patients with pyogenic liver abscess: A matched cohort study

Abstract Background Colorectal cancer (CRC) remains the third leading cause of death in the United States (US), and incidence has increased among patients < 50 years of age over the last few decades. Although many patients with early CRC remain asymptomatic, infections such as Streptococcus gallolyticus bacteremia, can be an early finding. There is increasing evidence that pyogenic liver abscesses (PLA) may also be associated with CRC. However, studies of US populations remain limited. Methods We retrospectively evaluated patients with a diagnosis of PLA at Veteran Health Administration hospitals across the US from 2003 to 2020. For each case, up to three uninfected controls matched for age (+/- 5), gender, and healthcare facilities at the time of index infection from the outpatient population were selected. PLA patients and matched controls were followed for ten years. Our primary outcome was a new diagnosis of CRC after index infection. Stratified cumulative incidence function plots with Gray’s test for equality were used to examine CRC incidence. Then we used Fine-Gray sub-distribution hazard regression models with interaction terms using the logarithm of time to estimate cause-specific time-dependent hazard ratios (HRs) for CRC incidence while accounting for mortality. Results We compared 8,294 PLA patients to 23,111 matched controls. Median age was 65.7 in PLA patients and 66.0 in matched controls. The median number of colonoscopies was ten in PLA patients and five in matched controls over the study period (p < 0.001). Our analysis revealed a 1.9% incidence of new CRC in the liver abscess group, compared to 0.8% in the matched cohort (p < 0.001, Figure 1). The multivariate sub-distribution hazard regression model showed higher time-dependent HRs of CRC up to two years from diagnosis of PLA but not higher afterward (Table 1). Incidence of colorectal cancer (CRC) in patients with liver abscess (dashed yellow line) compared to patients with no liver abscess (solid blue line). Our analysis revealed a 1.9% incidence of CRC in patients with liver abscess compared to 0.8% in the matched control cohort. Conclusion We found a significantly higher incidence of CRC for patients with PLA, especially during the first two years from diagnosis, although some of our findings may be explained by increased screening around the time of diagnosis. We believe our findings support the importance of CRC screening after the diagnosis of PLA. Disclosures Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.

Sleep pattern, healthy lifestyle and colorectal cancer incidence

Researchers have identified an association between lifestyle factors and colorectal cancer (CRC) risk. This study examined the relationship between sleep patterns and CRC events. 392,252 individuals were sampled from the UK Biobank. Chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness were combined to measure a healthy sleep score. A number of healthy sleep factors were defined, along with factors for healthy lifestyle scores. Using Cox proportional hazards regression, computed hazard ratios (HRs) were used to examine the associations between sleep patterns, healthy lifestyles, and the incidence of CRC. Healthy sleep scores were inversely associated with CRC events. The HRs for CRC were 0.90 (95% CI, 0.88–0.92) and 0.95 (95% CI, 0.92–0.98) for a 1-point healthy sleep score increase among males and females. When analyzing sleep components, sleeping 7–8 h/day, no frequent insomnia, no snoring, and no frequent daytime sleepiness were independently associated with a 9%, 14%, 8%, and 14% lower risk of CRC, respectively, whilst healthy lifestyle scores were inversely associated with CRC incidence across all models. Sleep pattern and lifestyle are significantly correlated with CRC risk. The healthier the subject’s lifestyle and sleep pattern, the lower their CRC risk.

Total calcium, dairy foods and risk of colorectal cancer: a prospective cohort study of younger US women.

Although colorectal cancer (CRC) incidence is declining among adults aged ≥65 years, CRC incidence in younger adults has been rising. The protective role of calcium in colorectal carcinogenesis has been well established, but evidence is lacking on whether the association varies by age at diagnosis. We investigated the association between total calcium intake and risk of overall CRC and CRC before age 55 years. In the Nurses' Health Study II (1991-2015), 94 205 women aged 25-42 years at baseline were included in the analysis. Diet was assessed every 4 years through validated food frequency questionnaires. Multivariable-adjusted hazard ratios (HRs) and 95% CIs for CRC were estimated using the Cox proportional hazards model. We documented 349 incident CRC cases during 2 202 604 person-years of follow-up. Higher total calcium intake was associated with a reduced risk of CRC. Compared with those with <750 mg/day of total calcium intake, the HR of CRC was 0.61 (95% CI, 0.38-0.97) for those who consumed ≥1500 mg/day (P for trend = 0.01). The HR per 300 mg/day increase was 0.85 (95% CI, 0.76-0.95). There was a suggestive inverse association between total calcium intake and CRC before age 55 years (HR per 300 mg/day increase, 0.87; 95% CI, 0.75-1.00), suggesting the importance of calcium intake in the younger population. In a cohort of younger women, which reflects the birth cohorts, time periods and age ranges paralleling the recent rise in CRC, higher calcium intake was associated with a decreased risk of CRC.

Colorectal Cancer in Childhood-onset Inflammatory Bowel Disease: A Scandinavian Register-based Cohort Study, 1969-2017.

Through linkage of data from Danish and Swedish national registers we identified 6937 patients with childhood (&lt;18 years)-onset Crohn disease (CD), 8514 patients with childhood-onset ulcerative colitis (UC) and up to 10 times as many matched (sex, age, residence) reference individuals 1969-2017. During follow-up to a median age of 27 (interquartile range = 21-39) years, 25 (0.36%) CD patients were diagnosed with colorectal cancer (CRC) versus 43 (0.06%) reference individuals, and 113 (1.33%) UC patients versus 45 (0.05%) reference individuals. The hazard ratio (HR) for CRC was 6.46 (95% CI = 3.95-10.6) in CD and 32.5 (95% CI = 23.0-45.9) in UC and increased with decreasing age at diagnosis. The HR for CRC was increased for all phenotypes, but with higher estimates for colonic CD [17.9 (95% CI = 7.43-43.3)] and UC with extensive/pancolitis [36.3 (95% CI = 22.8-57.8)]. The relative risk of CRC was increased for all phenotypes of childhood-onset inflammatory bowel disease. Age at onset may be considered an additional risk factor when implementing surveillance programs.

Abstract 3666: Dietary potassium and risk of colorectal cancer: Findings from the Singapore Chinese Cohort Study

Abstract Background: Colorectal cancer (CRC) is a commonly diagnosed subtype of cancer with a high mortality rate. Potassium is a necessary trace element in the human boy and is derived mainly from diet. Prior studies found high intakes of potassium was inversely associated with colorectal cancer occurrence in Western population. No such effort has been made in Asian population. Methods: We examined the associations for dietary potassium with the risk of CRC in the Singapore Chinese Health Study (SCHS), a population-based prospective cohort study that includes 61,321 Chinese men and women in Singapore who were 45-74 years of age at baseline. Daily intake of potassium was derived from the self-reported intake of pre-defined food items using a validated semi-quantitative food frequency questionnaire (FFQ) at baseline according to the Singapore Food Composition Table. Cox proportional hazard regression model was used to estimate the hazard ratios (HRs) and respective 95% confidence intervals (CIs) for CRC associated with higher quartile of potassium compared with the lowest quartile with adjustment for potential confounders. Results: After an average of 17.5 years of follow-up, 2,140 participants developed CRC. Dietary potassium was inversely associated with CRC risk. The multivariable-adjusted HR of CRC for the highest relative to the lowest quarter of daily potassium intake was 0.85 (95% CI 0.75-0.96, Ptrend=0.03). The inverse association between high intake of potassium and CRC risk was more apparent among participants with body mass index (BMI) ≥ 23 kg/m2 (HRQ4vsQ1=0.75, 95% CI: 0.63-0.89; Ptrend=0.003) and those with history of type 2 diabetes (HRQ4vsQ1=0.65, 95% CI: 0.42-1.00; Ptrend=0.36). Conclusions: In a large population-based prospective cohort study of more than 61,000 Chinese Singaporeans, we found inverse associations between dietary potassium intake and CRC risk. Future studies are warranted to elucidate the biological mechanism for the protective effect of potassium on the development of CRC. Citation Format: Hung N. Luu, Pedram Paragomi, Yi-Chuan Yu, Aizhen Jin, Renwei Wang, Robert E. Schoen, Woon-Puay Koh, Jian-Min Yuan. Dietary potassium and risk of colorectal cancer: Findings from the Singapore Chinese Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3666.

Long-term risk of colorectal cancer after removal of adenomas during screening colonoscopies in a large community-based population in China.

Patients with conventional adenoma removal are recommended to undergo colonoscopy surveillance to prevent colorectal cancer (CRC). However, evidence supporting the guidelines of colonoscopy surveillance is limited, especially among the Chinese population. We investigated the association between colonoscopy adenoma findings and CRC risk among individuals aged 40 to 74 years who underwent baseline colonoscopy from 2007 to 2016 in Jiashan and Haining, Zhejiang, China; 34 382 participants were categorized into advanced adenoma, nonadvanced adenoma and no adenoma based on adenoma findings. A multivariable Cox regression model was used to estimate the hazard ratio (HR) of CRC incidence with adjustment for potential confounding factors. After a median follow-up time of 7.7 years, 113 incident cases of CRC were identified (18 occurred in 1632 participants with advanced adenoma, 16 in 3973 participants with nonadvanced adenoma and 79 in 28 777 participants with no adenoma). Compared to no adenoma group, the adjusted HR for CRC in advanced adenoma group was 4.01 (95% CI, 2.37-6.77). For nonadvanced adenomas, individuals with ≥3 adenomas showed an increased risk of CRC (HR, 3.65; 95% CI, 1.43-9.31), but no significantly increased risk of CRC was found for 1 to 2 nonadvanced adenomas, compared to those with no adenoma. Our study suggested that the risk of subsequent CRC increased in individuals with high-risk adenoma (at least one advanced adenoma or ≥3 nonadvanced adenomas), but not in those with 1 to 2 nonadvanced adenomas. These results provide the first evidence from the Chinese population for the current surveillance guidelines.

Incident Crohn's Disease as a Risk Factor for Colorectal Cancer in the First 10 Years after Diagnosis: A Nationwide Population-Based Study.

We investigated the risk of colorectal cancer (CRC) in patients with Crohn’s disease (CD) using the claims data of the Korean National Health Insurance during 2006–2015. The data of 13,739 and 40,495 individuals with and without CD, respectively, were analyzed. Hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression tests. CRC developed in 25 patients (0.18%) and 42 patients (0.1%) of the CD and non-CD groups, respectively. The HR of CRC in the CD group was 2.07 (95% confidence interval (CI), 1.25–3.41). The HRs of CRC among men and women were 2.02 (95% CI 1.06–3.87) and 2.10 (95% CI, 0.96–4.62), respectively. The HRs of CRC in the age groups 0–19, 20–39, 40–59, and ≥60 years were 0.07, 4.86, 2.32, and 0.66, respectively. The HR of patients with late-onset CD (≥40 years) was significantly higher than that of those with early-onset CD (<40 years). CD patients were highly likely to develop CRC. Early-onset CD patients were significantly associated with an increased risk of CRC than matched individuals without CD. However, among CD patients, late-onset CD was significantly associated with an increased risk of CRC.

Systemic inflammation markers and cancer incidence in the UK Biobank

Systemic inflammation markers have been linked to increased cancer risk and mortality in a number of studies. However, few studies have estimated pre-diagnostic associations of systemic inflammation markers and cancer risk. Such markers could serve as biomarkers of cancer risk and aid in earlier identification of the disease. This study estimated associations between pre-diagnostic systemic inflammation markers and cancer risk in the prospective UK Biobank cohort of approximately 440,000 participants recruited between 2006 and 2010. We assessed associations between four immune-related markers based on blood cell counts: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and risk for 17 cancer sites by estimating hazard ratios (HR) using flexible parametric survival models. We observed positive associations with risk for seven out of 17 cancers with SII, NLR, PLR, and negative associations with LMR. The strongest associations were observed for SII for colorectal and lung cancer risk, with associations increasing in magnitude for cases diagnosed within one year of recruitment. For instance, the HR for colorectal cancer per standard deviation increment in SII was estimated at 1.09 (95% CI 1.02–1.16) in blood drawn five years prior to diagnosis and 1.50 (95% CI 1.24–1.80) in blood drawn one month prior to diagnosis. We observed associations between systemic inflammation markers and risk for several cancers. The increase in risk the last year prior to diagnosis may reflect a systemic immune response to an already present, yet clinically undetected cancer. Blood cell ratios could serve as biomarkers of cancer incidence risk with potential for early identification of disease in the last year prior to clinical diagnosis.

1637PD - Reaching sustainable oncology care via the National Cancer Control Program (NCCP)

BackgroundThe NCCP is a program of activities for efficient action in the field of cancer control adopted by our Government and based on recommendations of WHO and European Partnership Action Against Cancer. It was initiated due to high cancer incidence and mortality in our country. We report achievements of our 3 organized, population-based screening programs (SP). Methods1. Cervical Cancer (CerC) SP, started 2003, conventional cytology, 3 years interval, age 20–64, participation 72%. 2. Colorectal Cancer (CRC) SP, started 2009, immunochemical fecal occult blood test, follow up colonoscopy if positive, age 50-74, 2 years interval, participation 62%. 3. Breast Cancer (BC) SP, started 2008 in central region, countrywide in 2018, mammography every 2 years, age 50-69, participation 73%. Outcome measures: 1. Incidence for CerC and CRC for all pts diagnosed in Slovenia from SP start. 2. Stage distribution, net survival and hazard ratio (HR) of death for screen vs not screen detected cancers diagnosed with CerC, CRC and BC from 2011-2015 for all invited patients to the SPs. ResultsCerC incidence was reduced from 2003 to 2017 by 62% (from 211 cases/year to 85), CRC from 2010 to 2015 by 21% (from 1729 cases/year to 1357). A significant (p<0.0001) stage shift in screen detected vs not screen detected cancers was achieved. The stage shift percentages (screen detected/not screen detected) for the three SP are: for CerC stage I 81/41; stage II 16/30; stage III 3/19; stage IV 1/10, for CRC stage I 45/14; stage II 19/24; stage III 29/33; stage IV 8/30 and for BC stage I 66/40; stage II 26/35 stage III 8/18; stage IV 1/7. 5-year net survival for screen detected pts with CerC, CRC and BC was 92.1%, 88.4% and 100% and in not screen detected 63.7%, 57.1%, 85.3% respectively. The risk of death described by hazard ratio is in screened detected cancers 4-5 times lower: CerC HR 0.18 (0.11 – 0.28), CRC HR 0.26 (0.23-0.29) and BC HR 0.17 (0.10-0.31). ConclusionsHigh quality SPs have a significant impact on incidence, stage and survival and are the basis of sustainable oncology care. They are even more essential in countries with limited human and financial resources. Pts with screen detected cancers are diagnosed in earlier stages and have lower probability to die from cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps

Endoscopic screening reduces incidence and mortality of colorectal cancer (CRC) because precursor lesions, such as conventional adenomas or serrated polyps, are removed. Individuals with polypectomies are advised to undergo colonoscopy surveillance to prevent CRC. However, guidelines for surveillance intervals after diagnosis of a precursor lesion, particularly for individuals with serrated polyps, vary widely, and lack sufficient supporting evidence. Consequently, some high-risk patients do not receive enough surveillance and lower-risk subjects receive excessive surveillance. We examined the association between findings from first endoscopy and CRC risk among 122,899 participants who underwent flexible sigmoidoscopy or colonoscopy in the Nurses' Health Study 1 (1990-2012), Nurses' Health Study 2 (1989-2013), or the Health Professionals Follow-up Study (1990-2012). Endoscopic findings were categorized as no polyp, conventional adenoma, or serrated polyp (hyperplastic polyp, traditional serrated adenoma, or sessile serrated adenoma, with or without cytological dysplasia). Conventional adenomas were classified as advanced (≥10 mm, high-grade dysplasia, or tubulovillous or villous histology) or nonadvanced, and serrated polyps were assigned to categories of large (≥10 mm) or small (<10 mm). We used a Cox proportional hazards regression model to calculate the hazard ratios (HRs) of CRC incidence, after adjusting for various potential risk factors. After a median follow-up period of 10 years, we documented 491 incident cases of CRC: 51 occurred in 6161 participants with conventional adenomas, 24 in 5918 participants with serrated polyps, and 427 in 112,107 participants with no polyp. Compared with participants with no polyp detected during initial endoscopy, the multivariable HR for incident CRC in individuals with an advanced adenoma was 4.07 (95% confidence interval [CI] 2.89-5.72) and the HR for CRC in individuals with a large serrated polyp was 3.35 (95% CI 1.37-8.15). In contrast, there was no significant increase in risk of CRC in patients with nonadvanced adenomas (HR 1.21; 95% CI 0.68-2.16, P= .52) or small serrated polyps (HR 1.25; 95% CI 0.76-2.08; P= .38). These findings provide support for guidelines that recommend repeat lower endoscopy within 3 years of a diagnosis of advanced adenoma and large serrated polyps. In contrast, patients with nonadvanced adenoma or small serrated polyps may not require more intensive surveillance than patients without polyps.

Helicobacter pylori infection and the risk of colorectal cancer: a nationwide population-based cohort study.

The role of Helicobacter pylori (H. pylori) infection in the development of colorectal neoplasia has been a matter of scientific debate with controversial findings. This study examined the association between H. pylori infection and colorectal cancer (CRC) in a nationwide population-based Chinese cohort study. A total of approximately 3936 individuals with newly diagnosed H. pylori infection (the H. pylori-infected cohort) and 15744 age- and sex-matched patients with diagnoses absence of H. pylori infection (the comparison cohort) from 2000 to 2005 were identified from Taiwan's National Health Insurance Research Database. The Kaplan-Meier method was used for measuring the cumulative incidence of CRC in each cohort. Cox proportional hazards models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CIs) for the estimation of the association between H. pylori infection and CRC. The cumulative incidence of CRC was higher in H. pylori-infected cohort than that in the comparison cohort (log-rank test, P < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of CRC (adjusted HR 1.87; 95% CI 1.37-2.57). In addition, the HR of CRC appeared to increase with increasing frequency of clinical visits for H. pylori infection. Our study demonstrated that H. pylori infection was associated with an increased risk of CRC, which warrants confirmation and exploration of the underlying biologic mechanisms by future studies.

Diet and colorectal cancer in UK Biobank: a prospective study.

BackgroundMost of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s.MethodsWe used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40–69 years at recruitment (2006–10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time.ResultsDuring an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% [95% confidence interval (CI): 4–37] higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% (95% CI: 2–24) lower risk of colorectal cancer. Alcohol was associated with an 8% (95% CI: 4–12) higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk.ConclusionsConsumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (≤90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk.

Covering the Cover

Covering the Cover

Risk of colorectal cancer after a negative colonoscopy in low-to-moderate risk individuals: impact of a 10-year colonoscopy.

Background and study aims National societies recommend colorectal cancer (CRC) screening 10 years after a normal ("negative") colonoscopy in low-risk individuals. We studied the impact of a 10-year repeat colonoscopy on the risk of early incident CRC. Patients and methods We used health administrative data from Ontario, Canada, to conduct a population-based retrospective cohort study in 50 - 74-year-old individuals at low-to-moderate risk of CRC who had a negative colonoscopy between 1996 and 2001. We approximated exposure to repeat colonoscopy using an 8 - 12-year window. We excluded individuals who underwent lower endoscopy or colectomy, developed CRC, or were lost to follow-up between the baseline and repeat colonoscopies. We matched exposed individuals 1:1 to individuals who did not undergo lower endoscopy within 12 years for age, sex, and calendar year of baseline colonoscopy, and followed matched pairs for incident CRC. The primary analysis was multivariable hazards regression, adjusting for competing risks. Results A total of 13 350 matched pairs were observed for a median of 4.5 years (interquartile range 3.2 - 5.9 years). The cumulative probability of CRC following the matching date was 0.70 % (95 % confidence interval [CI] 0.42 % - 1.11 %) in individuals who underwent repeat colonoscopy and 0.77 % (95 %CI 0.48 % - 1.2 %) in individuals who did not undergo repeat colonoscopy. The adjusted hazard ratio for CRC was 0.91 (95 %CI 0.68 - 1.22). Conclusions We did not find an association between a second colonoscopy performed 10 years after a negative colonoscopy and early incident CRC. Our findings support the need for further studies on the utility of 10-year re-screening with colonoscopy in this setting.

The association between cholecystectomy and colorectal neoplasm in inflammatory bowel diseases: A population-based cohort study.

Background & aimsInflammatory bowel diseases (IBD) and cholecystectomy are associated with the risk of colorectal cancer (CRC). Our aim was to determine the association between cholecystectomy and the CRC risk in IBD.MethodsWe first obtained the Taiwan National Health Insurance Research Database (NHRID), which contains information on approximately 24.7 million insured individuals. A cohort study was conducted using the data from the NHIRD, and included cohort patients with IBD who had experienced a cholecystectomy between the years 1998 and 2010. The non-cholecystectomy cohort comprised the remaining IBD patients who had not undergone a cholecystectomy. Multivariate Cox proportional hazard regression analysis was used to determine the effects cholecystectomy have on the risks of developing CRC, as shown by Hazard Ratios (HRs) with 95% confidence intervals (CIs).ResultsThe incidence rate of CRC among IBD patients who had undergone a cholecystectomy (n = 525) was 1.75 per 1,000 person-years, compared to 1.41 per 1,000 person-years among IBD patients who had not had a cholecystectomy (n = 525). The adjusted HRs for CRC was found to be 0.76 (95% CI 0.25–2.32) for IBD patients having received a cholecystectomy, after adjusting for age, gender, and comorbidities. By type of IBD, neither ulcerative colitis nor Crohn’s diseases are associated with CRC after a cholecystectomy adjusted HR (2.78 [95% CI 0.54–14.3]) and (0.13 [95% CI 0.01–1.49]).ConclusionIn Taiwan, cholecystectomies are not associated with a risk of CRC in patients with IBD.

Periodontal disease, tooth loss and colorectal cancer risk: Results from the Nurses' Health Study.

Periodontal diseases including tooth loss might increase systemic inflammation, lead to immune dysregulation and alter gut microbiota, thereby possibly influencing colorectal carcinogenesis. Few epidemiological studies have examined the association between periodontal diseases and colorectal cancer (CRC) risk. We collected information on the periodontal disease (defined as history of periodontal bone loss) and number of natural teeth in the Nurses' Health Study. A total of 77,443 women were followed since 1992. We used Cox proportional hazard models to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjustment for smoking and other known risk factors for CRC. We documented 1,165 incident CRC through 2010. Compared to women with 25-32 teeth, the multivariable HR (95% CI) for CRC for women with <17 teeth was 1.20 (1.04-1.39). With regard to tumor site, the HRs (95% CIs) for the same comparison were 1.23 (1.01-1.51) for proximal colon cancer, 1.03 (0.76-1.38) for distal colon cancer and 1.48 (1.07-2.05) for rectal cancer. In addition, compared to those without periodontal disease, HRs for CRC were 0.91 (95% CI 0.74-1.12) for periodontal disease, and 1.22 (95% CI 0.91-1.63) when limited to moderate to severe periodontal disease. The results were not modified by smoking status, body mass index or alcohol consumption. Women with fewer teeth, possibly moderate or severe periodontal disease, might be at a modest increased risk of developing CRC, suggesting a potential role of oral health in colorectal carcinogenesis.

Consumption of Whole-Grain Bread and Risk of Colorectal Cancer among Norwegian Women (the NOWAC Study).

There is evidence that consumption of foods containing dietary fiber decreases the risk of colorectal cancer (CRC). Whole grains contain dietary fiber, as well as a range of micronutrients and bioactive compounds, but the association between the consumption of whole grains and the risk of CRC remains less studied. The aim of the present study was to investigate the association between whole-grain bread consumption and CRC incidence among Norwegian women, using data from a prospective cohort study (the Norwegian Women and Cancer Study). Dietary intake was estimated from the food-frequency questionnaires of 78,254 women in the cohort (median age: 55 years), and these women were then followed up for CRC incidence. During the 9 years of median follow-up, 795 women were diagnosed with CRC (316 proximal, 193 distal, 218 rectal). Associations between whole-grain bread consumption and the risk of CRC (including colorectal subsites) were investigated using Cox proportional hazards regression models. When compared to the low consumption group, the hazard ratio for CRC was 0.89 (95% confidence interval (CI): 0.72–1.09) for the high consumption group and 0.86 (95% CI: 0.72–1.02) for the medium consumption group in a multivariable model. Overall, no association between whole-grain bread consumption and CRC was found.

Time for a level playing field: inequalities in regulatory/approval processes—the example of bevacizumab in epithelial ovarian cancer.

As outsiders, we do not have access to the deliberations of the regulatory bodies. The NICE reasons are in the public domain. The Health Canada queries that led to Roche withdrawing their application are not known. Therefore, the following are possible explanations for this inconsistency. One possible reason that might be given for nonapproval: The clinical benefit is too small (Fig 1). This statement is incorrect. The PFS benefit that was obtained, as demonstrated by hazard ratios, ranged from 0.48 to 0.73 in EOC (superior in the recurrent setting). In comparison, hazard ratios for colorectal cancer were 0.50 to 0.89 and for lung cancer were 0.66 to 0.75. More relevantly, the absolute differences in median PFS were 3.3 to 5.5 months, 2 to 4.4 months, and 0.4 to 1.7 months, respectively, in these three cancer types. Is it that regulatory bodies need more than improvements in medians alone? This would be ideal but, unfortunately, is rarely the case because financial imperatives usually result in relatively immature data being submitted, leading to reliance on the medians. Even if longer term outcomes had been used as part of the decision making, they would not have had an adverse impact, given that the increases in survival at 1 and 2 years were clinically meaningful. Overall survival (OS) benefits were much less impressive. Hazard ratios again were 0.64 to 0.88, 0.66 to 0.94, and 0.79 to 0.93 in ovary, colorectal, and lung cancers. Absolute OS differences were 3.2 to 7.8 months, 0.4 to 4.4 months, and 0.5 to 2 months, respectively. These ovarian and colorectal outcomes are similar. Oncologists are convinced of bevacizumab’s utility. Bevacizumab is part of standard therapy in metastatic colorectal cancer. These outcomes in EOC are also regarded as worthwhile by Canadian oncologists. Support for use of bevacizumab was unanimous at a recent meeting of Gynecologic Oncology Canada (a pan-Canadian not-for-profit organization that represents physicians and nurses who specialize in gynecologic malignancies). Bevacizumab’s use is included in the National Comprehensive Cancer Network ovary guidelines in the platinum resistant/refractory setting in combination or as monotherapy. 21 The EMA, who approved it, found that there was “robust evidence for clinically significant effect.” 22(p47) However, some agencies were less enthusiastic. Documented reasons are available from NICE in the United Kingdom. 23,24 Lack of clinical benefit was not the only reason. The reasoning in the first-line setting was that,

Surveillance colonoscopy in elderly patients: a retrospective cohort study.

The risks and benefits of surveillance colonoscopy in elderly patients have not been well characterized. To investigate the relative impact of surveillance colonoscopy in elderly patients compared with a reference cohort. Retrospective cohort study from 2001 through 2010 of patients 50 years and older undergoing surveillance colonoscopy for a history of colorectal cancer (CRC) or adenomatous polyps at an integrated health care system in southern California. Patients were followed up from the surveillance examination until CRC diagnosis, death, disenrollment, IBD diagnosis, or study end date (December 31, 2010). The primary outcome measure was incidence of CRC detected following surveillance colonoscopy. The secondary outcome was risk of procedure defined as postprocedure hospitalization within 30 days. Cox regression and multivariable logistic regression analyses were used to determine the impact of age on CRC incidence on surveillance examination as well as postprocedure hospitalization, respectively. The study cohort included 4834 elderly patients (age ≥75 years; 55.8% male) (median surveillance age, 79 years) and 22 929 individuals in the reference group (age 50-74 years; 57.7% male) (median surveillance age, 63 years). A total of 373 cancers were detected following surveillance colonoscopy (368 in the reference group and 5 among the elderly patients). There were a total of 711 postprocedure hospitalizations (184 in the reference group and 527 among the elderly patients). The CRC incidence among elderly patients undergoing surveillance was 0.24 per 1000 person-years vs 3.61 per 1000 person-years in the reference population (P < .001). In Cox regression analysis, the hazard ratio for CRC in the elderly patients compared with the reference group was 0.06 (95% CI, 0.02-0.13) (P < .001) after adjusting for comorbid illness, sex, and race/ethnicity. In logistic regression analysis, age 75 years and older was independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 1.28 [95% CI, 1.07-1.53]; P = .006). Charlson score of 2 was also independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 2.54 [95% CI, 2.06-3.14]; P < .001). A low incidence of CRC and relatively high rate of postprocedure hospitalization were found among elderly patients undergoing surveillance colonoscopy. Recommendations for ongoing surveillance in the elderly population should take into consideration the impact of comorbid illness and increasing age on the anticipated risks and benefits of colonoscopy.