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Lower Gastrointestinal Bleeding And Risk of Gastrointestinal Cancer
Søren Viborg1, Kirstine Kobberøe Søgaard1, Dóra Körmendiné Farkas1
1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Lower gastrointestinal bleeding is a significant marker for prevalent gastrointestinal cancers, especially colorectal cancer (CRC). This condition also indicates an elevated risk for other GI cancers for over a year post-diagnosis.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Lower gastrointestinal (GI) bleeding is a known symptom of colorectal cancer (CRC).
- The association between incident GI bleeding and other GI cancers is not well-established.
Purpose of the Study:
- To investigate the risk of various GI cancer types in patients diagnosed with lower GI bleeding.
- To determine if lower GI bleeding serves as a marker for prevalent and incident GI cancers.
Main Methods:
- Nationwide cohort study using Danish medical registries (1995-2011).
- Identified patients with first-time lower GI bleeding diagnosis and followed for 10 years.
- Calculated absolute cancer risks and standardized incidence ratios (SIRs), accounting for competing risks.
Main Results:
- Among 58,593 patients, 2,806 GI cancers were observed.
- First-year GI cancer risk was 3.6% (SIR 16.3), with colorectal cancers being most common.
- Increased risks for various GI cancers persisted for 1-5 years, with elevated liver and pancreatic cancer risks beyond 5 years.
Conclusions:
- Hospital diagnosis of lower GI bleeding is a strong clinical marker for prevalent GI cancer, particularly CRC.
- Lower GI bleeding predicts an increased risk of any GI cancer for more than 1 year.
Objectives:
Lower gastrointestinal (GI) bleeding is a well-known symptom of colorectal cancer (CRC). Whether incident GI bleeding is also a marker of other GI cancers remains unclear.
Methods:
This nationwide cohort study examined the risk of various GI cancer types in patients with lower GI bleeding. We used Danish medical registries to identify all patients with a first-time hospital diagnosis of lower GI bleeding during 1995-2011 and followed them for 10 years to identify subsequent GI cancer diagnoses. We computed absolute risks of cancer, treating death as a competing risk, and calculated standardized incidence ratios (SIRs) by comparing observed cancer cases with expected cancer incidence rates in the general population.
Results:
Among 58,593 patients with lower GI bleeding, we observed 2,806 GI cancers during complete 10-year follow-up. During the first year of follow-up, the absolute GI cancer risk was 3.6%, and the SIR of any GI cancer was 16.3 (95% confidence interval (CI): 15.6-17.0). Colorectal cancers accounted for the majority of diagnoses, but risks of all GI cancers were increased. During 1-5 years of follow-up, the SIR of any GI cancer declined to 1.36 (95% CI: 1.25-1.49), but risks remained increased for several GI cancers. Beyond 5 years of follow-up, the overall GI cancer risk was close to unity, with reduced risk of rectal cancer and increased risk of liver and pancreatic cancers.
Conclusions:
A hospital-based diagnosis of lower GI bleeding is a strong clinical marker of prevalent GI cancer, particularly CRC. It also predicts an increased risk of any GI cancer beyond 1 year of follow-up.
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