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Mikaeel RR, Symonds EL, Kimber J, Smith E, Horsnell M, Uylaki W, Tapia Rico G, Hewett PJ, Yong J, Tonkin D, Jesudason D, Poplawski NK, Ruszkiewicz AR, Drew PA, Hardingham JE, Wong S, Frank O, Tomita Y, Patel D, Vatandoust S, Townsend AR, Roder D, Young GP, Parry S, Tomlinson IP, Wittert G, Wattchow D, Worthley DL, Brooks WJ, Price TJ, Young JP. Young-onset colorectal cancer is associated with a personal history of type 2 diabetes. Asia Pac J Clin Oncol 2020; 17:131-138. [PMID: 32885561 DOI: 10.1111/ajco.13428] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is rising in incidence in young adults, and this observation is currently unexplained. We investigated whether having a personal history of type 2 diabetes mellitus (T2D) was a potential risk factor for young-onset colorectal cancer (YOCRC). METHODS The South Australian Young Onset (SAYO) CRC study is a series of young adults with CRC below age 55. Ninety unrelated YOCRC cases were recruited to the study. Personal history and detailed family history of T2D were obtained at face-to-face interview and confirmed from medical records. Whole exome sequencing was conducted on germline DNA from each CRC case. Controls for personal history studies of T2D were 240 patients with proven clear colonoscopies and no known CRC predispositions. RESULTS The median age of YOCRC cases was 44 years (18-54) and of controls was 45 years (18-54), and 53% of both cases and controls were females (P = 0.99). Left-sided (distal) CRC was seen in 67/89 (75%) of cases. A personal history of T2D was confirmed in 17/90 (19%) YOCRC patients compared with controls (12/240, 5%; P < 0.001; odds ratio = 4.4; 95% confidence interval, 2.0-9.7). YOCRC patients frequently reported at least one first-degree relative with T2D (32/85, 38%). Ten of 87 (12%) of YOCRC cases had CRC-related pathogenic germline variants, however, no pathogenic variants in familial diabetes-associated genes were seen. CONCLUSIONS Though the mechanism remains unclear, our observations suggest that there is enrichment for personal history of T2D in YOCRC patients. IMPACT A diagnosis of T2D could therefore potentially identify a subset of young adults at increased risk for CRC and in whom early screening might be appropriate.
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Affiliation(s)
- Reger R Mikaeel
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute, Woodville South, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Biology Department, College of Science, University of Duhok, Duhok, Kurdistan, Iraq
| | - Erin L Symonds
- Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - James Kimber
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Eric Smith
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Mehgan Horsnell
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Wendy Uylaki
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Gonzalo Tapia Rico
- Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter J Hewett
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jonathan Yong
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Darren Tonkin
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew R Ruszkiewicz
- Division of Anatomical Pathology, SA Pathology, Adelaide, South Australia, Australia.,Centre for Cancer Biology, University of South Australia, Adelaide, South Australia, Australia
| | - Paul A Drew
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jenny E Hardingham
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute, Woodville South, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephanie Wong
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Oliver Frank
- Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Yoko Tomita
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Dainik Patel
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Sina Vatandoust
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Amanda R Townsend
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - Susan Parry
- New Zealand Familial GI Cancer Service, Auckland City Hospital, Auckland, New Zealand.,National Bowel Screening Programme, Ministry of Health, New Zealand
| | - Ian P Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Gary Wittert
- Discipline of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - David Wattchow
- Flinders University, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Daniel L Worthley
- South Australian Health & Medical Research Institute & School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - William J Brooks
- Adelaide Medical Solutions, Adelaide Health Solutions, Woodville, South Australia, Australia
| | - Timothy J Price
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne P Young
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute, Woodville South, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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