The prediction of colorectal cancer using anthropometric measures: A Swedish population‐based cohort study with 22 years of follow‐up

Abstract Background Whether or not the use of metformin decreases the risk of gastric adenocarcinoma is unclear. Methods This was a population-based cohort study in 2005–2015. Associations between metformin use and gastric non-cardia and cardia adenocarcinomas were examined within two cohorts; a diabetes cohort of participants using anti-diabetes medications, and a matched cohort of common-medication users, where metformin non-users were frequency matched (10:1) with metformin users for sex and age. Multivariable Cox proportional hazard regression analyses provided hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, calendar year, comorbidity, Helicobacter pylori eradication treatment, use of non-steroidal anti-inflammatory drugs or aspirin and use of statins. Results During the follow-up for a median of 5.8 years, 892 (0.1%) participants in the diabetes cohort and 6395 (0.1%) participants in the matched cohort of common-medication users developed gastric adenocarcinoma. Metformin users had no significantly decreased risk of gastric non-cardia adenocarcinoma (diabetes cohort: HR 0.93, 95% CI 0.78–1.12; matched cohort: HR 1.30, 95% CI 1.18–1.42) or cardia adenocarcinoma (diabetes cohort: HR 1.49, 95% CI 1.09–2.02; matched cohort: HR 1.58, 95% CI 1.38–1.81) compared with non-users in both cohorts. Conclusions This cohort study with <10 years of follow-up suggests metformin use may not prevent gastric adenocarcinoma.

Download Full-text

Prediagnostic use of estrogen-only therapy is associated with improved colorectal cancer survival in menopausal women: a Swedish population-based cohort study

Acta Oncologica ◽

10.1080/0284186x.2021.1909747 ◽

2021 ◽

pp. 1-7

Author(s):

Johanna Simin ◽

Qing Liu ◽

Xinchen Wang ◽

Katja Fall ◽

Cecilia Williams ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Cancer Survival ◽

Population Based ◽

Swedish Population ◽

Colorectal Cancer Survival ◽

Menopausal Women

Download Full-text

OP14 Risk of colorectal cancer diagnosis and colorectal cancer mortality in Crohn’s disease: A Scandinavian population-based cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.013 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S013-S014

Author(s):

O Olen ◽

R Erichsen ◽

M C Sachs ◽

L Pedersen ◽

J Halfvarson ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

General Population ◽

Cox Regression ◽

Population Based ◽

Tumour Stage ◽

Increased Risk

Abstract Background Crohn’s disease (CD) is a risk factor for colorectal cancer (CRC). Earlier studies reflect older treatment and surveillance strategies, and most have studied incident CRC without addressing potential lead-time and surveillance biases. Such bias can be reduced by examining tumour stage-adjusted CRC incidence and CRC mortality. We aimed to assess risks of CRC mortality and incident CRC among patients with CD compared with the general population. Methods Nationwide register-based cohort study during 1969–2017 of 47,035 patients with CD in Denmark (n = 13,056) and Sweden (n = 33,979), compared with 463,187 general population reference individuals, matched for sex, age, calendar year, and place of residence. We used Cox regression to estimate hazard ratios (HRs) for incident CRC and CRC mortality. In a multistate model, assessing competing events during follow-up (CRC diagnosis, CRC death, other death), we also took a tumour stage into account. Results During 1969–2017, 499 patients with CD developed CRC, corresponding to an adjusted HR of 1.40 [95% confidence interval (CI) 1.27–1.53]. We observed 296 (0.47/1000 person-years) deaths from CRC in patients with CD compared with 1968 (0.31/1000) in reference individuals [HR 1.74 (95% CI 1.54–1.96)]. CD patients diagnosed with CRC were at increased risk of CRC mortality compared with reference individuals also diagnosed with CRC [HR = 1.30 (95% CI 1.06–1.59)] and tumour stage at CRC diagnosis did not differ between groups (p = 0.27). CD patients who had 8 or more years of follow-up or who were diagnosed with primary sclerosing cholangitis (PSC) and hence were potentially eligible for CRC surveillance had an increased overall risk of CRC death [HR 1.41 (95% CI 1.18–1.69)] or CRC diagnosis [HR = 1.12 (95% CI = 0.98–1.28)]. However, in patients potentially eligible for CRC surveillance, we only found significantly increased risks in patients with CD onset <40 years, disease activity in the colon only, or with PSC (Figure 1). Conclusion CD patients are at increased risk of a CRC diagnosis and CRC death. Despite repeated colonoscopies during follow-up, CD patients are not diagnosed earlier (less severe tumour stage) with CRC than reference individuals. Nevertheless, CD patients with CRC have higher mortality than non-CD patients also diagnosed with CRC. CRC surveillance could likely be improved and should be focussed on CD patients <40 years at CD onset, patients with colon inflammation, and patients who have PSC.

Download Full-text

Changes in prescription of antidepressants and disability pension due to back pain, compared with other musculoskeletal and other somatic diagnoses: a cohort study in Sweden

BMJ Open ◽

10.1136/bmjopen-2019-029836 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029836

Author(s):

Annina Ropponen ◽

Syed Ghulam Rahman ◽

Pia Svedberg ◽

Magnus Helgesson ◽

Thomas Ernst Dorner ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Back Pain ◽

Repeated Measures ◽

Disability Pension ◽

Population Based ◽

Swedish Population ◽

Antidepressant Prescription ◽

Before And After

ObjectivesThe aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses.DesignA population-based cohort study with follow-up 3 years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures.Setting and participantsThis Swedish population-based nationwide study with registry data included individuals aged 18–64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809).Primary outcome measuresPrescription of antidepressants.ResultsBefore DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP.ConclusionsPathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.

Download Full-text

Trajectories of sickness absence and disability pension in colorectal cancer: a Swedish cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.697 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Chen ◽

K Alexanderson

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Sickness Absence ◽

Educational Level ◽

Disability Pension ◽

Population Based ◽

Work Situation ◽

Working Age ◽

Future Work ◽

Very High

Abstract Background Working-aged colorectal cancer (CRC) patients have a much better survival nowadays, indicating the importance of their future work situation. We aimed to investigate trajectories of sickness absence and disability pension (SADP) days before and after CRC diagnosis and in references, and risk factors associated with different trajectories. Methods A longitudinal, population-based matched cohort study of 4735 CRC survivors in Sweden aged 19-62 when first diagnosed with CRC in 2008-2011, and 18,230 matched references was conducted, using microdata linked from several nationwide registers. The annual SADP net days for 2 years before through 5 years after diagnosis date were computed. A group-based trajectory model was used to depict SADP trajectories. Associations between trajectory membership, and sociodemographic and clinical variables were tested by chi2 test and multinomial logistic regression. Results Four trajectories of SADP days/year for CRC survivors were identified: “only increase around diagnosis” (52% of all, n = 2481), “slight increase after diagnosis” (27%), “high then decrease moderately after diagnosis” (13%), and “constantly very high” (8%). Educational level (R2=0.022), Charlson's Comorbidity Index (R2=0.029), and prediagnostic mental disorders (R2=0.066) were the strongest factors determining the SADP trajectory groups. In references, three trajectories (”constantly low” (80% of all), “constantly moderate and decrease gradually” (12%), and “very high then decrease overtime” (8%)) were identified. Conclusions Approximately 80% of CRC survivors return to a low level of SADP (0-60 days/year) at 5 years postdiagnosis. Prediagnostic status of mental disorders, somatic comorbidity, and low educational level are good indicators of future high SADP levels for CRC survivors. Key messages Most of working-age colorectal cancer survivors have low levels of sickness absence and disability pension days five years after their diagnosis. Trajectory analyses based on population-based register data can be used as a good approach in understanding future work situation regarding sick leave among working-age cancer survivors.

Download Full-text

Anorectal Malformations and the Risk of Colorectal Cancer—Is Early Routine Endoscopic Screening Indicated?

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1718749 ◽

2020 ◽

Author(s):

Anna Svenningsson ◽

Anna Gunnarsdottir ◽

Tomas Wester

Keyword(s):

Colorectal Cancer ◽

Early Adulthood ◽

Anorectal Malformations ◽

Population Based ◽

Observational Period ◽

Endoscopic Screening ◽

Medical Birth Register ◽

National Patient ◽

And Gender

Abstract Introduction Colorectal cancer (CRC) has been reported in early adulthood in patients with anorectal malformation (ARM), and therefore, the need of endoscopic controls has been discussed. The aim of this study was to assess the risk of CRC in patients with ARM. Materials and Methods This was a nationwide population-based study with data from Swedish national health care registers. All patients diagnosed with ARM born in Sweden between 1964 and 1999 were identified in the National Patient Register. The same group was followed up in the Swedish Cancer Register from birth to December 31, 2014, for occurrences of CRC. Five age- and gender-matched individuals randomly selected from the Medical Birth Register served as controls for each ARM patient born between 1973 and 1999. Results A total of 817 patients (474 males) with ARM were included and followed up from birth to the end of observational period. Time of follow-up ranged from 15 to 50 years (mean: 28 years). None of the patients was diagnosed with CRC during the observational period. One case of rectal cancer and one case of sigmoid cancer were detected among the 3,760 controls. Conclusion In our study, the risk of CRC in early adulthood in patients with ARM is low. Our result does not support routine endoscopic follow-up for patients with ARM during the first decade of life.

Download Full-text