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Abu-Sbeih H, Ali FS, Ge PS, Barcenas CH, Lum P, Qiao W, Bresalier RS, Bhutani MS, Raju GS, Wang Y. Patients with breast cancer may be at higher risk of colorectal neoplasia. Ann Gastroenterol 2019; 32:400-406. [PMID: 31263363 PMCID: PMC6595931 DOI: 10.20524/aog.2019.0387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/17/2019] [Indexed: 11/11/2022] Open
Abstract
Background The risk of colorectal neoplasia in breast cancer survivors is unclear. This study aimed to determine the colonic adenoma detection rate (ADR) in patients with breast cancer. Methods We conducted a retrospective study of patients with breast cancer who underwent a colonoscopy between 2000 and 2017. A control group (n=3295), comprising cancer-free patients undergoing their first screening colonoscopy, was used for comparison. Results Of 62,820 breast cancer patients, 3304 met the inclusion criteria. The mean age at the time of first colonoscopy was 59 years. ADR was 55%; 1803 patients had adenomas. High-grade dysplasia was evident in 28% of polyps and invasive adenocarcinoma was detected in 172 patients (5%). The median time from breast cancer diagnosis to adenoma detection was 3 years. The ADR was 21% in patients aged <40 years (n=63) and 39% in patients aged 40-50 years (n=314). The ADR was 26% in patients <50 years with a body mass index (BMI) lower than 30 kg/m2 or no family history of colorectal cancer. Multivariate logistic regression analysis revealed that the following independent factors were associated with a greater risk of colon adenoma: older age, higher BMI, family history of colorectal cancer, and personal history of breast cancer. Conclusions In patients with breast cancer, the ADR was higher than the reported rates for the general population. Screening colonoscopy should be considered soon after breast cancer diagnosis in patients <50 years of age. Further prospective studies investigating our findings are warranted.
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Affiliation(s)
- Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Faisal S Ali
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL (Faisal S. Ali)
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (Carlos H. Barcenas)
| | - Phillip Lum
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (Wei Qiao), USA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
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Lai JH, Park G, Gerson LB. Association between breast cancer and the risk of colorectal cancer. Gastrointest Endosc 2017; 86:429-441.e1. [PMID: 28433614 DOI: 10.1016/j.gie.2017.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature to date has suggested a potential increase in colorectal cancer (CRC) among patients with breast cancer. METHODS We performed a systematic review of the literature and included 37 retrospective cohort studies and 8 case-control studies. The primary aim was to determine the prevalence of CRC. Secondary aims included analysis of adenomatous polyps and analysis of CRC prevalence by age. We calculated pooled prevalence rates and odds ratios (ORs) using random effects models with 95% confidence intervals (CI). RESULTS We identified 1,055,917 individuals with breast cancer among whom 9097 cases of CRC were detected. The pooled event rate for CRC was 0.7% (95% CI, 0.6%-0.9%; I2=97%). Four case-control studies reported prevalence of CRC (N=17,873 patients with breast cancer and 70,366 controls), including 46 cases of CRC in the patients with breast cancer, and 272 CRC in the controls (OR, 1.2; 95% CI, 0.4%-3.7%; P = .7). Six studies reported prevalence of advanced adenomas in patients with breast cancer (N=1087) compared with controls (N=1356) with 62 cases of advanced adenomas in patients compared with 47 in the controls (OR, 1.5; 95% CI, 0.97-2.2; P = .07). In patients with breast cancer <50 years old (4 studies, N=64,706), the pooled OR was increased (OR, 2.5; 95% CI, 1.7-3.5; P =.001). In 3 studies of women <45 years old (N=92,594), the risk was increased (OR, 2.3; 95% CI, 1.7-2.6; P < .001). CONCLUSIONS Patients with breast cancer should not undergo CRC screening at intervals different from the general population. In patients with breast cancer <50 years old, CRC screening should be considered at age 45 years.
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Affiliation(s)
- Jennifer H Lai
- Department of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Gavin Park
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
| | - Lauren B Gerson
- Department of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, California, USA
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Rozen P, Fireman Z, Fine N, Chetrit A, Zajicek G. Rectal epithelial proliferation in women recovered from breast cancer. Cancer Lett 1990; 55:189-94. [PMID: 2257537 DOI: 10.1016/0304-3835(90)90118-h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Women recovered from breast cancer are at increased risk for colorectal neoplasia. The reasons may be genetic, dietary or endogenous hormonal risk factors. Measurements of rectal epithelial proliferation are a useful biomarker of risk for large bowel cancer. This was studied in 12 women after (mean 7.8 years) cured breast cancer, who had a mean % labelling index of 7.5 +/- 3.5 (S.D.) as compared to 5.8 +/- 1.8 (S.D.) in a disease-free comparison group of 25 women. In addition, analysis of labelled crypt compartments demonstrated a significantly higher proportion in the study group with thymidine uptake, mainly in the mid crypt zone, and an extension of crypt cell DNA synthesis towards the surface epithelium. Using proliferative activity as a biomarker of risk in a larger study group, we may learn more about common etiological factors for both malignancies and also identify a higher-risk subgroup for long-term follow-up and possible therapeutic intervention.
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Affiliation(s)
- P Rozen
- Department of Gastroenterology, Tel-Aviv Medical Center, Jerusalem, Israel
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