Risk Of Colorectal Cancer Mortality Research Articles

Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death

The fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening, but evidence of its effectiveness is limited. To evaluate whether FIT screening is associated with a lower risk of dying from CRC overall, according to cancer location, and within demographic groups. This nested case-control study in a cohort of screening-eligible people was conducted in 2 large, integrated health systems of racially, ethnically, and socioeconomically diverse members with long-term programs of mailed FIT screening outreach. Eligible participants included people aged 52 to 85 years who died from colorectal adenocarcinoma between 2011 and 2017 (cases); cases were matched in a 1:8 ratio based on age, sex, health-plan membership duration, and geographic area to randomly selected persons who were alive and CRC-free on case's diagnosis date (controls). Data analysis was conducted from January 2002 to December 2017. Completing 1 or more FIT screenings in the 5-year period prior to the CRC diagnosis date among cases or the corresponding date among controls; in secondary analyses, 2- to 10-year intervals were evaluated. The primary study outcome was CRC death overall and by tumor location. Secondary analyses were performed to assess CRC death by race and ethnicity. From a cohort of 2 127 128 people, a total of 10 711 participants (3529 aged 60-69 years [32.9%]; 5587 male [52.1%] and 5124 female [47.8%]; 1254 non-Hispanic Asian [11.7%]; 973 non-Hispanic Black [9.1%]; 1929 Hispanic or Latino [18.0%]; 6345 non-Hispanic White [59.2%]) was identified, including 1103 cases and 9608 controls. Among controls during the 10-year period prior to the reference date, 6101 (63.5%) completed 1 or more FITs with a cumulative 12.6% positivity rate (768 controls), of whom 610 (79.4%) had a colonoscopy within 1 year. During the 5-year period, 494 cases (44.8%) and 5345 controls (55.6%) completed 1 or more FITs. In regression analysis, completing 1 or more FIT screening was associated with a 33% lower risk of death from CRC (adjusted odds ratio [aOR], 0.67; 95% CI, 0.59-0.76) and 42% lower risk in the left colon and rectum (aOR, 0.58; 95% CI, 0.48-0.71). There was no association with right colon cancers (aOR, 0.83; 95% CI, 0.69-1.01) but the difference in the estimates between the right colon and left colon or rectum was statistically significant (P = .01). FIT screening was associated with lower CRC mortality risk among non-Hispanic Asian (aOR, 0.37; 95% CI, 0.23-0.59), non-Hispanic Black (aOR, 0.58; 95% CI, 0.39-0.85) and non-Hispanic White individuals (aOR, 0.70; 95% CI, 0.57-0.86) (P for homogeneity = .04 for homogeneity). In this nested case-control study, completing FIT was associated with a lower risk of overall death from CRC, particularly in the left colon, and the associations were observed across racial and ethnic groups. These findings support the use of FIT in population-based screening strategies.

Impact of hormone replacement therapy on all‐cause and cancer‐specific mortality in colorectal cancer: A systematic review and dose‒response meta‐analysis of observational studies

Impact of hormone replacement therapy on all‐cause and cancer‐specific mortality in colorectal cancer: A systematic review and dose‒response meta‐analysis of observational studies

Routine Fecal Occult Blood Screening and Colorectal Cancer Mortality in Sweden

Population-based colorectal cancer (CRC) screening programs are implemented worldwide, but there are difficulties evaluating their effectiveness. The magnitude of routine CRC screening effectiveness regarding cancer-specific mortality is unclear. To evaluate cancer-specific mortality associated with early vs late or no invitation for routine CRC screening using fecal occult blood testing. This prospective cohort study was performed in the region of Stockholm-Gotland, Sweden, between January 1, 2008, and December 31, 2021. All individuals of the target population of screening born from 1938 to 1954 were included. Data were analyzed from December 12, 2022, to June 25, 2023. Individuals were invited early (2008-2012), late (2013-2015), or not at all to screening with biennial guaiac-based fecal occult blood test. The early invitation group was considered the exposure group and the late or no invitation group was considered the control group. The main outcome was cancer-specific mortality, defined as CRC registered in the Cancer Register with CRC as underlying cause of death in the Cause of Death Register. Excess mortality was calculated as all-cause deaths among the individuals with CRC subtracted from the expected number of deaths had they not had CRC. Poisson regression analysis based on deaths and person-years was used to estimated mortality rate ratio (RR) with 95% CIs, adjusted for follow-up years and attained age. In total, 379 448 individuals (193 436 [51.0%] female) were invited for CRC screening, including 203 670 individuals in the exposure group and 175 778 in the control group. The mean screening participation rate was 63.3%, and there was a maximum of 14 years follow-up. There were 834 CRC deaths in 2 190 589 person-years in the exposure group, compared with 889 CRC deaths in 2 249 939 person-years in the control group. Individuals who underwent early CRC screening had reduced adjusted risk of CRC mortality (RR, 0.86; 95% CI, 0.78-0.95) and excess mortality (RR, 0.84; 95% CI, 0.75-0.93). This prospective cohort study of routine screening with fecal occult blood testing found a 14% decrease in CRC mortality associated with screening. The true association of screening with reduced mortality is expected to be higher due to some coexistence of testing in the control group and CRC deaths diagnosed more than 2 years after screening.

The effect of air pollution on the risk of inflammatory bowel disease, colorectal cancer and appendicitis

Introduction and objective
 Intense industrial development is contributing to increased emissions of air pollutants. Numerous studies indicate a link between air pollution and a higher risk of pulmonary and cardiovascular diseases. Our goal is to analyze available scientific studies to demonstrate the relationship between air pollution and the risk of developing and complicating inflammatory bowel disease, colorectal cancer and appendicitis.
 Brief description of the state of knowledge
 Air pollution is a global health challenge. Particles such as PM, nitrogen oxides, sulfur oxides or ozone have a significant impact on health. Studies suggest a link between pollution and intestinal diseases (IBD, CRC, appendicitis). Air pollutants can affect the gut by causing inflammation, oxidative stress and disruption of the gut microbiota. Exposure to PM2.5 can increase the risk of IBD, CRC, and PM10 can increase the risk of UC. There is a correlation between pollution and the rate of hospitalization for IBD. In addition, exposure to PM2.5 increases the risk of colorectal cancer mortality. Short-term exposure to air pollution is associated with more hospitalizations for appendicitis.
 Summary
 Air pollution is a real health risk. Reducing air pollution could potentially reduce the risk of developing these intestinal diseases and their complications. Despite the potential links, further research is required to better understand the mechanisms of action of pollutants on intestinal health. Urgent and coordinated global and local action is needed to reduce air pollution emissions and protect the health of the public.

Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening.

Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening colonoscopy every 10 years vs annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. The MIcrosimulation SCreening ANalysis (MISCAN) model used observed sequential screening adherence, HSgFOBT positivity, and diagnostic colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (single-screening colonoscopy vs ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening or 10 yearly screening colonoscopy vs annual HSgFOBT with 100% and differential observed adherence from the trial. Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval 15.8-26.9) and 6.9 (5.0-9.2) per 1,000 participants, respectively. In the case of 100% adherence, only screening colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening colonoscopy and 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening colonoscopy vs HSgFOBT was 0.75 (95% probability interval 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable-as observed in the national colonoscopy study, microsimulation, comparative effectiveness, screening recommendations.

High blood pressure and colorectal cancer mortality in a 29-year follow-up of the Japanese general population: NIPPON DATA80.

Onco-hypertension has been proposed, although associations of high blood pressure (BP) with cancer risk remain inconsistent. We examined associations of high BP with risk of mortality from stomach, lung, colorectal, liver, and pancreatic cancers independent of possible confounders in an analysis that excluded deaths within the first 5 years of follow-up to consider the reverse causality. In a prospective cohort representative of the general Japanese population (1980-2009), we studied 8088 participants (mean age, 48.2 years; 56.0% women) without clinical cardiovascular disease or antihypertensive medication at baseline. Fine-Gray competing risks regression was used to estimate hazard ratios for 10 mmHg higher BP adjusted for confounders including smoking, alcohol-drinking, obesity, and diabetes mellitus. During 29-year follow-up, 159 (2.0%), 159 (2.0%), 89 (1.1%), 86 (1.1%), and 68 (0.8%) participants died from stomach, lung, colorectal, liver, and pancreatic cancers, respectively. We observed a positive association of high BP with risk of colorectal cancer mortality but not with mortality risks from any other cancers. The association with colorectal cancer mortality for systolic and diastolic BP was evident in those aged 30-49 years (hazard ratios 1.43 [95% confidence interval, 1.22-1.67] and 1.86 [1.32-2.62], respectively) but not in those aged 50-59 years and ≥60 years (P for age interaction <0.01 for systolic and diastolic BP). The associations with colorectal cancer mortality were similar in the analyses stratified by smoking, alcohol-drinking, obesity, and diabetic status. In conclusion, high BP among young to middle-aged adults was independently associated with risk of colorectal cancer mortality later in life.

Associations between colorectal cancer risk and dietary intake of tomato, tomato products, and lycopene: evidence from a prospective study of 101,680 US adults.

Previous epidemiological studies have yielded inconsistent results regarding the effects of dietary tomato, tomato products, and lycopene on the incidence of colorectal cancer (CRC), possibly due to variations in sample sizes and study designs. The current study used multivariable Cox regression, subgroup analyses, and restricted cubic spline functions to investigate correlations between CRC incidence and mortality and raw tomato, tomato salsa, tomato juice, tomato catsup, and lycopene intake, as well as effect modifiers and nonlinear dose-response relationships in 101,680 US adults from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. During follow-up 1100 CRC cases and 443 CRC-specific deaths occurred. After adjustment for confounding variables, high consumption of tomato salsa was significantly associated with a reduced risk of CRC incidence (hazard ratio comparing the highest category with the lowest category 0.8, 95% confidence interval 0.65-0.99, p for trend = 0.039), but not with a reduced risk of CRC mortality. Raw tomatoes, tomato juice, tomato catsup, and lycopene consumption were not significantly associated with CRC incidence or CRC mortality. No potential effect modifiers or nonlinear associations were detected, indicating the robustness of the results. In the general US population a higher intake of tomato salsa is associated with a lower CRC incidence, suggesting that tomato salsa consumption has beneficial effects in terms of cancer prevention, but caution is warranted when interpreting these findings. Further prospective studies are needed to evaluate its potential effects in other populations.

Faecal haemoglobin concentration predicts all-cause mortality

BackgroundPopulation-based screening for colorectal cancer by a faecal immunochemical test (FIT) is recommended by the European Union. Detectable faecal haemoglobin can indicate colorectal neoplasia as well as other conditions. A positive FIT predicts an increased risk of death from colorectal cancer but might also predict an increased risk of all-cause mortality. MethodsA cohort of screening participants was followed using the Danish National Register of Causes of Death. Data were retrieved from the Danish Colorectal Cancer Screening Database supplemented with FIT concentrations. Colorectal cancer specific and all-cause mortality were compared between FIT concentration groups using multivariate cox proportional hazards regression models. FindingsIn 444,910 Danes invited for the screening program, 25,234 (5·7%) died during a mean follow-up of 56·5 months. Colorectal cancer caused 1120 deaths. The risk of colorectal cancer death increased with the increasing FIT concentration. The hazard ratios ranged from 2·6 to 25·9 compared to individuals with FIT concentrations <4 μg hb/g faeces. Causes other than colorectal cancer caused 24,114 deaths. The risk of all-cause death increased with the increasing FIT concentration, with the hazard ratios ranging from 1·6 to 5·3 compared to individuals with FIT concentrations <4 μg hb/g faeces. InterpretationThe risk of colorectal cancer mortality increased with the increasing FIT concentrations even for FIT concentrations considered negative in all European screening programs. The risk of all-cause mortality was also increased for individuals with detectable faecal blood. For colorectal cancer specific mortality and all-cause mortality, the risk was increased at the FIT concentrations as low as 4–9 μg hb/g faeces. FundingThe study was funded by the Odense University Hospital grants A3610 and A2359.

Abstract A074: Contribution of neighborhood and clinical factors to differences in early-onset colorectal cancer mortality across different racial and ethnic groups

Abstract Objectives: We investigated racial and ethnic differences in colorectal cancer (CRC) mortality in adults with early onset colorectal cancer (ages &amp;lt;50; EO-CRC) in California and quantified the contribution of sociodemographic, health system, and clinical factors to racial and ethnic disparities in mortality. Methods: California Cancer Registry data were used to estimate CRC-specific mortality for adults ages 18-49 with EO-CRC between 2000-2019 for each racial/ethnic group (non-Hispanic Black [NHB], Hispanic, Asian American, American Indian/Alaska Native [AIAN], Native Hawaiian/Pacific Islander [NHPI]) compared with non-Hispanic White (NHW) adults. Additional disaggregated comparisons were conducted in Asian American ethnic groups: Chinese, Filipino, Japanese, Korean, South Asian, Southeast Asian, Other Asian and NHPI, compared to NHW individuals and separately using Chinese adults as a referent group. Cox proportional hazards models were used to measure association between race/ethnicity and CRC mortality risk, yielding unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) accounting for sociodemographic, clinical and health system factors, with corresponding 95% confidence intervals (95% CI). Mediation analyses were conducted to measure the percentage of contribution of factors to overall racial/ethnic CRC mortality rates using a sequence of multivariable Cox models. Results: There were 22,997 adults ages 18-49 with an EO-CRC diagnosis between 2000-2019, with 3,544 Asian (1,039 deaths), 6,889 Hispanic (1,998 deaths), 125 AIAN (36 deaths), 1,668 NHB (670 deaths), 10,473 NHW (3,089 deaths), 135 NHPI (51 deaths) and 163 (&amp;lt;5 deaths) unknown race/ethnicity adults. Compared to NHW adults, higher CRC mortality was shown for NHPI adults (HR=1.69; 95% CI: 1.27-2.23; aHR=1.36; 95% CI: 1.03-1.79) and NHB adults (HR=1.53; 95% CI: 1.41-1.66; aHR=1.17; 95% CI: 1.07-1.29). Hispanic adults had an increased risk of CRC mortality in the unadjusted model (HR=1.15, 95% CI: 1.09-1.22) that was attenuated in the adjusted model (aHR=0.99, 95% CI: 0.92-1.04), compared to NHW adults. After disaggregating the Asian American group, Southeast Asian adults had increased CRC mortality risk in the unadjusted (HR=1.29, 95% CI: 1.13-1.46) but not adjusted model (aHR=1.10; 95% CI: 0.97-1.26), compared to NHW adults. In mediation analyses that examined contributors to the association between race/ethnicity and CRC mortality risk, neighborhood socioeconomic status and insurance status were among the top five most influential factors for Hispanic, NHB, and NHPI adults. However, the magnitude of influence differed by racial and ethnic group. Conclusions: Compared to NHWs, NHPI and NHB adults with EO-CRC had increased CRC mortality risk, even after adjusting for clinical and sociodemographic factors. Mediation analyses highlighted variation in the importance of various sociodemographic, clinical, health system and neighborhood factors, underscoring the need to better disentangle factors within racial and ethnic groups that contribute to disparities in CRC-related mortality. Citation Format: Joshua Demb, Scarlett Gomez, Alison Canchola, Alexander Qian, James D. Murphy, Samir Gupta, Maria Elena Martinez. Contribution of neighborhood and clinical factors to differences in early-onset colorectal cancer mortality across different racial and ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A074.

Colonoscopic Screening and Risk of All-Cause and Colorectal Cancer Mortality in Young and Older Individuals.

The incidence of early-onset colorectal cancer (CRC) and associated mortality have been increasing. However, the potential benefits of CRC screening are largely unknown in young individuals. We aimed to evaluate the effect of CRC screening with colonoscopy on all-cause and CRC mortality among young (aged < 45 years) and older (aged ≥ 45 years) individuals. This cohort study included 528,046 Korean adults free of cancer at baseline who underwent a comprehensive health examination. The colonoscopic screening group was defined as those who reported undergoing colonoscopy for CRC screening. Mortality follow-up until December 31, 2019 was ascertained based on nationwide death certificate data from the Korea National Statistical Office. Colonoscopic screening was associated with a lower risk of all-cause mortality in both young and older individuals. Multivariable-adjusted time-dependent hazard ratios (95% confidence intervals) for all-cause mortality comparing ever- to never-screening were 0.86 (0.75-0.99) for young individuals and 0.71 (0.65-0.78) for older individuals. Colonoscopic screenings were also associated with a reduced risk of CRC mortality without significant interaction by age, although this association was significant only among participants aged ≥ 45 years, with corresponding time-dependent hazard ratios of 0.47 (0.15-1.44) for young individuals and 0.52 (0.31-0.87) for those aged ≥ 45 years. Colonoscopic CRC screening decreased all-cause mortality among both young and older individuals, while significantly decreased CRC mortality was observed only in those aged ≥ 45 years. Screening initiation at an earlier age warrants more rigorous confirmatory studies.

Cigarette Smoking Associated with Colorectal Cancer Survival: A Nationwide, Population-Based Cohort Study.

We investigate whether cigarette smoking is associated with survival in patients with colorectal cancer (CRC) through a nationwide population-based cohort study in Taiwan. The Taiwan Cancer Registry and National Health Insurance Research Database were used to identify data from patients with CRC from 2011 to 2017. Tobacco use was evaluated based on the smoking status, intensity, and duration before cancer diagnosis. A total of 18,816 patients was included. A Kaplan–Meier survival analysis indicated smoking to be significantly associated with the CRC mortality risk (log-rank p = 0.0001). A multivariable Cox model indicated that smoking patients had a 1.11-fold higher mortality risk (HR = 1.11, 95% CI = 1.05–1.19) than nonsmoking patients did. This increased risk was also present in patients with CRC who smoked 11–20 cigarettes per day (HR = 1.16; 95% CI = 1.07–1.26) or smoked for >30 years (HR = 1.14; 95% CI = 1.04–1.25). Stratified analyses of sex and cancer subsites indicated that the effects of smoking were higher in male patients and in those with colon cancer. Our results indicate that cigarette smoking is significantly associated with poor survival in patients with CRC. An integrated smoking cessation campaign is warranted to prevent CRC mortality.

633Poorly controlled diabetes is a predictor of colorectal cancer survival

Abstract Background Epidemiological studies have shown diabetes associated with increased risk of colorectal cancer. This study investigates the impact of a pre-cancer diabetes-related hospitalization record on colorectal cancer survival. Methods A retrospective cohort of 13190 colorectal cancer patients recorded on the South Australian Cancer Registry in 2003-2013 were examined. Diabetes-related hospitalization histories were obtained using linked inpatient data. Colorectal cancer deaths were available for 2003-2013. The association of survival from colorectal cancer with diabetes-related hospitalization history was assessed using competing risk analysis, adjusting for sociodemographic factors and cancer stage at diagnosis. Results 2765 patients with colorectal cancer (26.5%) had a history of hospital admission for diabetic complications, the most common being multiple complications (32%), followed by kidney and eye complications. The 5- and 10-year cancer survival probabilities were 63% and 56% in those with a diabetes complication history, significantly lower than 66% and 60% for patients without these complications (adjusted sub hazard ratio 1.11, 95% CI 1.02-1.20). Risk of colorectal cancer death was lower when theses diabetes-related hospitalizations were earlier than the year of cancer diagnosis - i.e., adjusted SHR 0.80, 95% CI 0.66-0.97 for 3-5 and 0.76, 95% CI 0.59-0.98 for 6+ years before the cancer diagnosis compared with same-year hospitalizations. Conclusions Colorectal cancer patients with a history of diabetes-related hospitalization have poorer survival, particularly if these hospitalizations were in the same year as the cancer diagnosis. Key messages Poorly controlled diabetes histories predict increased risk of colorectal cancer mortality.

Positive impact of a faecal-based screening programme on colorectal cancer mortality risk.

The effectiveness of colorectal cancer (CRC) screening programs is directly related to participation and the number of interval CRCs. The objective was to analyse specific-mortality in a cohort of individuals invited to a CRC screening program according to type of CRC diagnosis (screen-detected cancers, interval cancers, and cancers among the non-uptake group). Retrospective cohort that included invitees aged 50-69 years of a CRC screening program (target population of 85,000 people) in Catalonia (Spain) from 2000-2015 with mortality follow-up until 2020. A screen-detected CRC was a cancer diagnosed after a positive faecal occult blood test (guaiac or immunochemical); an interval cancer was a cancer diagnosed after a negative test result and before the next invitation to the program (≤24 months); a non-uptake cancer was a cancer in subjects who declined screening. A total of 624 people were diagnosed with CRC (n = 265 screen-detected, n = 103 interval cancers, n = 256 non-uptake). In the multivariate analysis, we observed a 74% increase in mortality rate in the group with interval CRC compared to screen-detected CRC adjusted for age, sex, location and stage (HR: 1.74%, 95% CI:1.08-2.82, P = 0.02). These differences were found even when we restricted for advanced-cancers participants. In the stratified analysis for type of faecal occult blood test, a lower mortality rate was only observed among FIT screen-detected CRCs. CRC screening with the FIT was associated with a significant reduction in CRC mortality.

Predictors of Colorectal Cancer Screening Among African American Men Living with HIV.

African American men living with HIV are at high risk of colorectal cancer (CRC). Screening to detect CRC is associated with a reduced risk of CRC mortality. However, little is known about CRC screening predictors in this population. This study examined the relation of self-efficacy, a potential mediator of screening that interventions could target, to CRC screening. It also investigated several variables that might identify subpopulations of African American men non-adherent to CRC screening recommendations. We report a secondary analysis on baseline data from a randomized controlled trial of a health promotion intervention for African American men living with HIV. Before their intervention, they completed measures of CRC screening, self-efficacy, marital status, age, education, and adherence to physical activity guidelines and were assessed for obesity. A total of 270 African American men aged 45 to 88 (Mean = 55.07; SD = 6.46) living with HIV participated. About 30% reported CRC screening in the past six months. Multiple logistic regression revealed greater CRC screening self-efficacy and meeting physical activity guidelines were associated with receiving CRC screening. Obese men and men reporting higher education were less likely to report screening. Age and marital status were unrelated to screening. The results of this study suggest CRC screening rates may be low among African American men living with HIV, and interventions targeting self-efficacy may improve their screening uptake. Moreover, public-health efforts to increase screening should prioritize interventions with subpopulations of African American men living with HIV who are physically inactive and obese.

Television Viewing Time and the Risk of Colorectal Cancer Mortality among Japanese Population: The JACC Study.

PurposeSedentary behavior attributes to the increased risk of some cancers and all-cause mortality. The evidence is limited for the association between television (TV) viewing time, a major sedentary behavior, and risk of colorectal cancer death. We aimed to examine this association in Japanese population.Materials and MethodsA prospective cohort study encompassed of 90,834 men and women aged 40–79 years with no prior history of colorectal cancer who completed a self-administered food frequency questionnaire, and provided their TV viewing information. The participants were followed-up from 1988–1990 to the end of 2009. The hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by the Cox proportional hazard regression for risk of colorectal cancer mortality according to TV viewing time.ResultsDuring the median 19.1-year follow-up period, we documented 749 (385 men and 364 women) colorectal cancer deaths. The multivariable-adjusted HRs for mortality from colorectal cancer were 1.11 (0.88–1.41) for 1.5 to < 3 hr/day, 1.14 (0.91–1.42) for 3 to < 4.5 hr/day and 1.33 (1.02–1.73) for ≥ 4.5 hr/day in comparison to < 1.5 hr/day TV watching; p-trend=0.038, and that for 1-hour increment in TV viewing time was 1.06 (1.01–1.11). Moreover, the multivariable-adjusted HR (95% CI) of colon cancer for 1-hour increment in TV viewing time was 1.07 (1.02–1.13). Age, body mass index, and level of leisure-physical activity did not show significant effect modifications on the observed associations.ConclusionTV viewing time is associated with the increased risk of colorectal cancer mortality among Japanese population, more specifically colon rather than rectal cancer.

The impact of social determinants on receipt of colonoscopy in an under-resourced hospital service area: A retrospective cohort study.

216 Background: Although colorectal cancer (CRC) screening with colonoscopy reduces the risk of CRC mortality, screening rates remain low among African Americans and low social economic status (SES) patients. However, few studies have assessed CRC screening rates in under-resourced hospital service areas. Using a granular measure of socioeconomic deprivation (SED), we examined the association between social determinants and CRC screening. Methods: We conducted a retrospective cohort study from 2014-2019 to identify primary care patients referred for CRC screening with colonoscopy at an academic hospital system. Patients were assessed at annual visits for completion of colonoscopy. SED was assessed using the area deprivation index (ADI), a composite measure of 17 SED indicators including income, housing, education, and employment at the census block group level. Other social determinants analyzed were race and insurance status. Frequency and multivariable logistic regression were used for statistical analysis. Results: 1040 patients met CRC screening guidelines and were referred for colonoscopy. 136 (13.1%) underwent colonoscopy in the follow-up period. High and low SED made up 655 (63%) and 77 (7.4%) of patients, respectively. SED, race, age, and sex were not associated with higher screening rates. Uninsured patients had a lower rate of screening. After controlling for other social determinants, uninsured patients had the lowest odds of colonoscopy (OR 0.28; 95% CI, 0.08-0.92). Conclusions: In this under-resourced hospital service area, receipt of colonoscopy for CRC screening is significantly lower than previously reported. Furthermore, screening rates were persistently low across strata of SED, race and insurance status, with uninsured patients having the lowest odds of screening. These data suggest that in an under-resourced hospital service area with extensive SED, further research is needed to understand the role of social determinants and behavioral factors to address disparities in CRC screening with colonoscopy. [Table: see text]

Colorectal cancer mortality after spinal cord injury

Context: Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the US. There is paucity of data regarding CRC and the spinal cord injury (SCI) community. Persons with SCI have suboptimal rates of colonoscopies and face extensive barriers to care. The aim of our study was to compare CRC mortality in persons with SCI to CRC mortality in the general population. Design: A prospective follow-up study. Setting: Analysis of the National SCI database. Participants: 54,965 persons with SCI. Interventions: Not applicable. Outcome Measures: Current survival status and causes of death were determined. The expected number of CRC deaths was calculated for the general US population, using ICD-10 codes. Standardized mortality ratios (SMR) were calculated as the ratio of observed to expected CRC deaths stratified by current age, sex, race, time post-injury and neurologic group. Results: The CRC mortality was 146 persons out of 54,965 persons with SCI. The overall SMR was determined to be 1.11 (95% CI [0.94, 1.31]). Among subgroups, one finding was significant and this was for patients with injury level C1-4 with an American Spinal Injury Association Impairment Scale Grade of A, B or C with an SMR of 1.68 ([95% CI [1.03–2.61]). Conclusion: Although persons with SCI receive suboptimal rates of preventative care screenings and report extensive barriers to care, overall, they are not at an increased risk of CRC mortality. The current recommendations for CRC screening should be continued for these individuals while reducing barriers to care.

Abstract 2357: Lipid-lowering drug use, duration of use, and age at first use is associated with a lower risk of colorectal cancer mortality in men and women in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract Background: While lipid-lowering drugs, particularly statins, are associated with a modestly reduced risk of developing colorectal cancer (CRC), the association of lipid-lowering drug use, duration of use, and age at first use with CRC mortality in men and women without the diagnosis at baseline, has not been well studied. Further, whether associations are similar across race is unknown. Thus, we aimed to characterize the association between lipid-lowering drug use and CRC mortality in men and women and by race. We classified lipid-lowering drug use in a time-dependent manner as current use, duration of use, and age at first use. Methods: We conducted a prospective cohort study of 14,428 cancer-free men and women attending visit 2 (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. Death from CRC was ascertained from the underlying cause on death certificates. Follow-up began at visit 2 and ended at date of death or 12/31/2015, whichever came first. There were 384 incident CRC cases and 144 deaths in 290,249 person-years. Cox regression was used to estimate relative hazards (HR) and 95% confidence intervals (CI) for CRC incidence and death adjusting for age, sex, education, race and field center, BMI, smoking status and pack years, alcohol use, red and processed meat consumption, aspirin use, and family history of any cancer and family history of CRC overall and by gender and race. Current lipid-lowering medication use, duration of use (&amp;lt;15 years, ≥15 years), and age at first use (&amp;lt;50, 50-59, 60-69, and ≥70 years of age) were modeled as time-dependent variables. Results: Mean age was 57 years and mean BMI was 28.1 kg/m2; 54.9% were women and 27.9% were Black. By visit 4 (1996-98), after an average of 6 years of follow-up, 22% of participants were using lipid-lowering drugs. Compared to never users, current use was associated with 53% lower risk of CRC death (HR 0.47; 95%CI 0.32-0.71). Inverse associations were present in both men (HR 0.59; 95%CI 0.35-0.99) and women (HR 0.37; 95%CI 0.20-0.69) and in Black (HR 0.44; 95%CI 0.19-1.00) and White (HR 0.49; 95%CI 0.31-0.77) participants. Inverse associations were consistent across different patterns of duration of use and was inverse irrespective of age at first use. Current use was also associated with a lower risk of CRC incidence (HR: 0.72; 95%CI 0.57-0.92). Conclusions: Current use of lipid-lowering drugs was associated with a statistically significant lower risk of dying from CRC in participants without cancer at baseline, including men and women and in Black and white participants, irrespective of the duration (15 year intervals) or age at first use. Support: NHLBI contracts, NCI grants, NPCR Citation Format: Michael T. Marrone, John R. Barber, Alison M. Mondul, Anna E. Prizment, David Couper, Corinne E. Joshu, Elizabeth A. Platz. Lipid-lowering drug use, duration of use, and age at first use is associated with a lower risk of colorectal cancer mortality in men and women in the Atherosclerosis Risk in Communities (ARIC) Study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2357.

Colorectal cancer in Crohn's disease: a Scandinavian population-based cohort study

Crohn's disease is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance strategies, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account. Such biases can be accounted for by assessing CRC incidence by tumour stage and CRC mortality by tumour stage. We aimed to assess rates of incident CRC and CRC mortality among patients with Crohn's disease compared with the general population. For this nationwide register-based cohort study, we used International Classification of Disease codes in national patient registers and pathology reports to identify incident cases of Crohn's disease. In Denmark we searched for incident cases between January, 1977, and December, 2011, and in Sweden between January, 1969, and December, 2017. For each patient with Crohn's disease, we identified up to ten reference individuals in national population registers and matched them by sex, age, calendar year, and place of residence. Matched reference individuals had to be alive and free of inflammatory bowel disease at the start of follow-up of index patients with Crohn's disease, and stopped contributing to reference person-years if they were diagnosed with inflammatory bowel disease. Our main outcome was death from CRC (main or contributory cause of death) as captured in the cause-of-death registers. Our secondary outcome was incident CRC, as defined by the cancer registers. We used Cox regression to estimate hazard ratios (HRs) for incident CRC and CRC mortality, taking tumour stage into account. We used a series of Cox models to estimate cause-specific HRs of the different competing outcomes (CRC diagnosis, CRC death, and other causes of death) and adjusted for tumour stage at CRC diagnosis. During the 1969-2017 study period, we identified 47 035 patients with incident Crohn's disease (13 056 in Denmark and 33 979 in Sweden) and 463 187 matched reference individuals. During follow-up, 296 (0·47 per 1000 person-years) CRC deaths occurred among individuals with Crohn's disease compared with 1968 (0·31 per 1000 person-years) in reference individuals, corresponding to an overall adjusted HR of 1·74 (1·54-1·96). 499 (0·82 per 1000 person-years) cases of incident CRC were diagnosed in patients with Crohn's disease compared with 4084 (0·64 per 1000 person-years) cases in reference individuals, corresponding to an overall adjusted HR of 1·40 (95% CI 1·27-1·53). Patients with Crohn's disease who were diagnosed with CRC were at increased risk of CRC mortality compared with reference individuals also diagnosed with CRC (HR 1·42 [1·16-1·75] when adjusted for tumour stage), and tumour stage at CRC diagnosis did not differ between groups (p=0·27). Patients with Crohn's disease who had follow-up of 8 years or longer or who were diagnosed with primary sclerosing cholangitis (PSC) and hence were potentially eligible for CRC surveillance had an increased overall risk of CRC death (HR 1·40 [1·16-1·68]) or CRC diagnosis (HR 1·12 [0·98-1·28]). However, in patients potentially eligible for CRC surveillance we only found significantly increased risks in patients diagnosed with Crohn's disease before the age of 40 years, patients with disease activity in the colon only, or patients with PSC. Patients with Crohn's disease are at increased risk of CRC diagnosis and CRC death. Patients with Crohn's disease who have CRC have a higher mortality than patients without Crohn's disease who are also diagnosed with CRC. CRC surveillance should likely be focused on patients diagnosed with Crohn's disease before the age of 40 years, on patients with colon inflammation, and on those who have PSC. Swedish Medical Society, Karolinska Institutet, Regional Agreement on Medical Training and Clinical Research between Stockholm County Council and Karolinska Institutet (ALF), Forte Foundation, Swedish Cancer Foundation, and Independent Research Fund Denmark.

OP14 Risk of colorectal cancer diagnosis and colorectal cancer mortality in Crohn’s disease: A Scandinavian population-based cohort study

Abstract Background Crohn’s disease (CD) is a risk factor for colorectal cancer (CRC). Earlier studies reflect older treatment and surveillance strategies, and most have studied incident CRC without addressing potential lead-time and surveillance biases. Such bias can be reduced by examining tumour stage-adjusted CRC incidence and CRC mortality. We aimed to assess risks of CRC mortality and incident CRC among patients with CD compared with the general population. Methods Nationwide register-based cohort study during 1969–2017 of 47,035 patients with CD in Denmark (n = 13,056) and Sweden (n = 33,979), compared with 463,187 general population reference individuals, matched for sex, age, calendar year, and place of residence. We used Cox regression to estimate hazard ratios (HRs) for incident CRC and CRC mortality. In a multistate model, assessing competing events during follow-up (CRC diagnosis, CRC death, other death), we also took a tumour stage into account. Results During 1969–2017, 499 patients with CD developed CRC, corresponding to an adjusted HR of 1.40 [95% confidence interval (CI) 1.27–1.53]. We observed 296 (0.47/1000 person-years) deaths from CRC in patients with CD compared with 1968 (0.31/1000) in reference individuals [HR 1.74 (95% CI 1.54–1.96)]. CD patients diagnosed with CRC were at increased risk of CRC mortality compared with reference individuals also diagnosed with CRC [HR = 1.30 (95% CI 1.06–1.59)] and tumour stage at CRC diagnosis did not differ between groups (p = 0.27). CD patients who had 8 or more years of follow-up or who were diagnosed with primary sclerosing cholangitis (PSC) and hence were potentially eligible for CRC surveillance had an increased overall risk of CRC death [HR 1.41 (95% CI 1.18–1.69)] or CRC diagnosis [HR = 1.12 (95% CI = 0.98–1.28)]. However, in patients potentially eligible for CRC surveillance, we only found significantly increased risks in patients with CD onset &amp;lt;40 years, disease activity in the colon only, or with PSC (Figure 1). Conclusion CD patients are at increased risk of a CRC diagnosis and CRC death. Despite repeated colonoscopies during follow-up, CD patients are not diagnosed earlier (less severe tumour stage) with CRC than reference individuals. Nevertheless, CD patients with CRC have higher mortality than non-CD patients also diagnosed with CRC. CRC surveillance could likely be improved and should be focussed on CD patients &amp;lt;40 years at CD onset, patients with colon inflammation, and patients who have PSC.