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Colorectal Cancer Risk in Patients with Hemorrhoids: A 10-Year Population-Based Retrospective Cohort Study
En-Bo Wu1, Fung-Chang Sung2,3,4, Cheng-Li Lin3
1Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
Insights
Individuals with hemorrhoids have a significantly higher risk of developing colorectal cancer (CRC). This study found CRC incidence was 2.39 times greater in those with hemorrhoids, suggesting increased surveillance is warranted.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Colorectal cancer (CRC) is a major global health concern.
- Hemorrhoids are a common condition, but their association with CRC risk is not fully understood.
Purpose of the Study:
- To investigate the association between hemorrhoids and the risk of developing colorectal cancer (CRC).
- To determine if a history of hemorrhoids increases CRC incidence.
Main Methods:
- Retrospective cohort study using Taiwan's National Health Insurance Research Database.
- Propensity score matching was used to create comparable cohorts with and without hemorrhoids.
- Follow-up until 2011 to assess CRC incidence and hazard ratios (HR).
Main Results:
- The incidence rate of CRC was 2.39 times higher in the hemorrhoid cohort compared to the control cohort (adjusted HR = 2.18).
- Elevated CRC risk was observed particularly in the rectum and sigmoid colon.
- Third cohort analysis suggested potential overmatching effects.
Conclusions:
- Patients with hemorrhoids face an elevated risk of developing colorectal cancer.
- Colonoscopy screening is recommended for individuals with hemorrhoids, especially those with positive fecal occult blood tests.
Abstract:
Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan's National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78-2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48-3.28) and 1.79 (95% CI = 1.06-3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.
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