Department of Gastroenterology, Kaiser Permanente Northern California, Fremont, California, USA
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
BMJ Open Gastroenterol. 2022 Jul;9(1). doi: 10.1136/bmjgast-2022-000947.
Iron deficiency anaemia (IDA) in women aged 20-49 years may be caused by menses or gastrointestinal cancer. Data are sparse on the yield of endoscopy/colonoscopy in this population. Our aim was to determine the association of IDA and symptoms with cancers.
Retrospective cohort study within Kaiser Permanente Northern California. Participants were women aged 20-49 years tested for iron stores and anaemia during 1998, 2004 and 2010 and followed for 5 years for outcomes of oesophageal, gastric and colon cancers. Symptoms from the three prior years were grouped into dysphagia, upper gastrointestinal (UGI), lower gastrointestinal (LGI), rectal bleeding and weight loss.
Among 9783 anaemic women aged 20-49 years, there were no oesophageal, 6 gastric and 26 colon cancers. Incidences per 1000 for gastric cancer with and without iron deficiency (ID) were 0.60 (95% CI 0.23 to 1.55) and 0.63 (95% CI 0.17 to 2.31), and for colon cancer, 2.72 (95% CI 1.72 to 4.29) and 2.53 (95% CI 1.29 to 4.99). Endoscopies for UGI or dysphagia symptoms rather than bidirectional endoscopy for ID yielded more gastric cancers (n=5 and n=4, respectively) with fewer procedures (3793 instead of 6627). Colonoscopies for LGI or rectal bleed instead of for ID would detect more colon cancers (n=19 and n=18) with about 40% of the procedures (=2793/6627).
UGI and colon cancers were rare in women of menstruating age and when controlled for anaemia were as common without as with ID. Using symptoms rather than IDA as an indication for endoscopy found equal numbers of cancers with fewer procedures.
20-49 岁女性缺铁性贫血（IDA）可能由月经或胃肠道癌症引起。关于该人群内镜/结肠镜检查的结果数据很少。我们的目的是确定 IDA 和症状与癌症的关联。
Kaiser Permanente 北加利福尼亚的回顾性队列研究。参与者为 1998 年、2004 年和 2010 年期间接受铁储备和贫血检查的 20-49 岁女性，并在 5 年内随访食管、胃和结肠癌的结局。前 3 年的症状分为吞咽困难、上胃肠道（UGI）、下胃肠道（LGI）、直肠出血和体重减轻。
在 9783 名 20-49 岁贫血女性中，没有食管癌，6 例胃癌和 26 例结肠癌。胃癌和缺铁（ID）的发病率分别为 0.60（95%CI 0.23 至 1.55）和 0.63（95%CI 0.17 至 2.31），结肠癌的发病率为 2.72（95%CI 1.72 至 4.29）和 2.53（95%CI 1.29 至 4.99）。与 ID 相比，针对 UGI 或吞咽困难症状的内镜检查而不是双向内镜检查可发现更多的胃癌（分别为 n=5 和 n=4），且操作较少（3793 次而非 6627 次）。针对 LGI 或直肠出血而不是 ID 的结肠镜检查可发现更多的结肠癌（分别为 n=19 和 n=18），且操作约减少 40%（=2793/6627）。
育龄期女性的 UGI 和结肠癌很少见，且在控制贫血的情况下，IDA 无或有与贫血时一样常见。使用症状而不是 ID 作为内镜检查的指征可发现相同数量的癌症，且操作更少。
