女性乳腺癌患者患结直肠癌的风险增加。

Increased risk of colorectal cancer in patients diagnosed with breast cancer in women.

作者信息

Lu Yunxia, Segelman Josefin, Nordgren Ann, Lindström Lina, Frisell Jan, Martling Anna

机构信息

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

出版信息

Cancer Epidemiol. 2016 Apr;41:57-62. doi: 10.1016/j.canep.2016.01.006. Epub 2016 Jan 27.

DOI:10.1016/j.canep.2016.01.006

PMID:26826682

Abstract

BACKGROUND

Epidemiological studies have shown a potential association between sex hormones and colorectal cancer. The risk of colorectal cancer in breast cancer patients who may have been exposed to increased levels of endogenous sex hormones and/or exogenous sex hormones (e.g. anti-hormonal therapy) has not been thoroughly evaluated.

METHODS

Using the National Swedish Cancer Register we established a population-based prospective cohort of breast cancer patients in women diagnosed in Sweden between 1961 and 2010. Subsequent colorectal cancers were identified from the same register. Standardized incidence ratios (SIRs) and 95% confidence intervals (95%CIs) were used to estimate the risk of colorectal cancer after a diagnosis of breast cancer. The association between breast cancer therapy and risk of colorectal cancer was evaluated in a subcohort of breast cancer patients treated in Stockholm between 1977 and 2007. Hazard ratios (HRs) and 95%CIs were estimated using Cox regression models.

RESULTS

In a cohort of 179,733 breast cancer patients in Sweden, 2571 incident cases of colorectal cancer (1008 adenocarcinomas in the proximal colon, 590 in the distal colon and 808 in the rectum) were identified during an average follow-up of 9.68 years. An increased risk of colorectal adenocarcinoma was observed in the breast cancer cohort compared with that in the general population (SIR=1.59, 95%CI: 1.53, 1.65). Adenocarcinoma in the proximal colon showed a non-significantly higher SIR (1.72, 95%CI: 1.61, 1.82) compared with the distal colon (1.46, 95%CI: 1.34, 1.58). In the subcohort of 20,171 breast cancers with available treatment data, 299 cases with colorectal cancers were identified. No treatment-dependent risk of colorectal cancer was observed among the breast cancer patients.

CONCLUSION

An increased risk of colorectal adenocarcinoma - especially in the proximal colon - was observed in the breast cancer cohort. Breast cancer treatment did not alter this risk.

摘要

背景

流行病学研究表明性激素与结直肠癌之间存在潜在关联。对于可能接触过内源性性激素水平升高和/或外源性性激素（如抗激素治疗）的乳腺癌患者，其患结直肠癌的风险尚未得到充分评估。

方法

利用瑞典国家癌症登记处，我们建立了一个基于人群的前瞻性队列，纳入了1961年至2010年在瑞典确诊的女性乳腺癌患者。后续的结直肠癌病例从同一登记处识别。标准化发病比（SIR）和95%置信区间（95%CI）用于估计乳腺癌诊断后患结直肠癌的风险。在1977年至2007年于斯德哥尔摩接受治疗的乳腺癌患者亚队列中，评估乳腺癌治疗与结直肠癌风险之间的关联。使用Cox回归模型估计风险比（HR）和95%CI。

结果

在瑞典的179,733例乳腺癌患者队列中，在平均9.68年的随访期间，识别出2571例结直肠癌发病病例（近端结肠腺癌1008例，远端结肠腺癌590例，直肠癌808例）。与一般人群相比，乳腺癌队列中结直肠腺癌的风险增加（SIR = 1.59，95%CI：1.53，1.65）。近端结肠腺癌的SIR（1.72，95%CI：1.61，1.82）与远端结肠腺癌（1.46，95%CI：1.34，1.58）相比，略高但无统计学意义。在有可用治疗数据的20,171例乳腺癌亚队列中，识别出299例结直肠癌病例。在乳腺癌患者中未观察到与治疗相关的结直肠癌风险。