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Breast cancer survivors diagnosed at younger age show higher risk for colon cancer
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Women diagnosed with breast cancer before age 50 were twice as likely to receive a diagnosis of colorectal cancer than their older counterparts, according to the results of a meta-analysis published in Gastrointestinal Endoscopy.
Lauren B. Gerson, MD, of California Pacific Medical Center and University of California, San Francisco, and colleagues concluded that these patients could begin colorectal cancer (CRC) screening at age 45.
“Many women with breast cancer ... are often referred ... for colorectal cancer screening, and the question that often comes up in the community is whether these patients should be screened more often than patients who do not have breast cancer, and at what age the screening should be undertaken,” Gerson said in a video abstract. “We know from reviewing the literature that the prevalence of colorectal cancer in these patients has been around 1%, and so the goal of our study was to try to determine if the prevalence in breast cancer patients was higher than has been reported in the past.”
“Breast cancer is one of the most common cancers in women and they actually have a great survival, so we need to really make sure that the recommendations for surveillance of secondary cancers is appropriate,” Jennifer H. Lai, MD, of California Pacific Medical Center, added in the video abstract.
The researchers reviewed medical literature published through 2015, and analyzed data from 37 retrospective cohort studies and eight case-control studies, with the primary aim of determining CRC prevalence. They identified 1,055,917 women with breast cancer (mean age, 57 years), 9,097 of whom also had CRC, for a pooled CRC rate of 0.7% (95% CI, 0.6-0.9).
Four of the case-control studies showed CRC prevalence was not significantly different between women with and without breast cancer, with 46 of 17,873 women with breast cancer diagnosed with CRC compared with 272 of 70,366 controls (OR = 1.2; 95% CI, 0.4-3.7).
Similarly, six studies showed the prevalence of advanced adenomas was not significantly different between these groups, with 62 cases of advanced adenomas detected in 1,087 women with breast cancer compared with 47 of 1,356 controls (OR = 1.5; 95% CI, 0.97-2.2).
However, four studies showed a significantly higher CRC prevalence among 64,706 women with breast cancer aged younger than 50 years (OR = 2.5; 95% CI, 1.7-3.5), and three studies showed a similar result in 92,594 women with breast cancer aged younger than 45 years (OR = 2.3; 95% CI, 1.7-2.6).
These results show that CRC prevalence “in breast cancer survivors is not different than the general population, and therefore women with history of breast cancer should just be screened for [CRC] at age-appropriate intervals,” Lai said in the video abstract. “This, however, may be different in women who are diagnosed with breast cancer at a younger age ... Based on this data it is reasonable to say that a woman who is diagnosed with breast cancer at younger than age 50 should consider having her initial screening colonoscopy at age 45, but of course this needs more research and validation.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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