Association between breast cancer and the risk of colorectal cancer

• Published in: Gastrointestinal endoscopy Vol. 86; no. 3; pp. 429 - 441.e1
• Main Authors: Lai, Jennifer H., MD, Park, Gavin, MD, Gerson, Lauren B., MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adenoma - epidemiology; Adenomatous Polyps - epidemiology; Age Factors; Breast Neoplasms - epidemiology; Carcinoma - epidemiology; Colonic Polyps - epidemiology; Colorectal Neoplasms - epidemiology; Gastroenterology and Hepatology; Humans; Intestinal Polyps - epidemiology; Odds Ratio; Prevalence; Risk Factors; Surveillance, Epidemiology, and End Results Database; colorectal cancer; OR; CRC; CI; SEER; confidence interval; odds ratio
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.04.008

Background The literature to date has suggested a potential increase in colorectal cancer (CRC) among patients with breast cancer. Methods We performed a systematic review of the literature and included 37 retrospective cohort studies and 8 case-control studies. The primary aim was to determine the prevalence of CRC. Secondary aims included analysis of adenomatous polyps and analysis of CRC prevalence by age. We calculated pooled prevalence rates and odds ratios (ORs) using random effects models with 95% confidence intervals (CI). Results We identified 1,055,917 individuals with breast cancer among whom 9097 cases of CRC were detected. The pooled event rate for CRC was 0.7% (95% CI, 0.6%-0.9%; I2 =97%). Four case-control studies reported prevalence of CRC (N=17,873 patients with breast cancer and 70,366 controls), including 46 cases of CRC in the patients with breast cancer, and 272 CRC in the controls (OR, 1.2; 95% CI, 0.4%-3.7%; P = .7). Six studies reported prevalence of advanced adenomas in patients with breast cancer (N=1087) compared with controls (N=1356) with 62 cases of advanced adenomas in patients compared with 47 in the controls (OR, 1.5; 95% CI, 0.97-2.2; P  = .07). In patients with breast cancer <50 years old (4 studies, N=64,706), the pooled OR was increased (OR, 2.5; 95% CI, 1.7-3.5; P =.001). In 3 studies of women <45 years old (N=92,594), the risk was increased (OR, 2.3; 95% CI, 1.7-2.6; P < .001). Conclusions Patients with breast cancer should not undergo CRC screening at intervals different from the general population. In patients with breast cancer <50 years old, CRC screening should be considered at age 45 years.