Cancer risk in patients with diverticular disease: A nationwide cohort study

Abstract

BACKGROUND There are little data on diverticular disease and cancer development, other than colorectal cancer. METHODS We conducted a population-based, matched cohort study with linkage of nationwide registers to the ESPRESSO histopathology cohort. We included 75,704 patients with a diagnosis of diverticular disease and colorectal histopathology and 313,480 reference individuals from the general population matched on age, sex, calendar year, and county. Cox proportional hazards models estimated multivariable-adjusted hazard ratios (HRs) for associations between diverticular disease and overall cancer and specific cancers. RESULTS Over a median follow-up of 6 years, we documented 12,846 incident cancers among patients with diverticular disease and 43,354 incident cancers among reference individuals from the general population. Compared to reference individuals, patients with diverticular disease had significantly increased overall cancer incidence (24.5 vs. 18.1 per 1,000 person-years), equivalent to 1 extra cancer case in 16 individuals with diverticular disease followed for ten years. After adjusting for covariates, having a diagnosis of diverticular disease was associated with a 33% increased risk of overall cancer (95% confidence interval (CI)=1.31-1.36). The risk increases also persisted compared to siblings as secondary comparators (HR = 1.26; 95%CI = 1.21-1.32). Patients with diverticular disease also had increased risk of specific cancers, including colon cancer (HR = 1.71; 95%CI = 1.60-1.82), liver cancer (HR = 1.72; 95%CI = 1.41-2.10), pancreatic cancer (HR = 1.62; 95%CI = 1.42-1.84), and lung cancer (HR = 1.50; 95%CI = 1.39-1.61). The increase in colorectal cancer risk was primarily restricted to the first year of follow-up, and especially early cancer stages. CONCLUSIONS Patients with diverticular disease who have colorectal histopathology have an increased risk of overall incident cancer.

Association between diverticular disease and colorectal cancer: a bidirectional mendelian randomization study

“…The present MR study found that genetic predisposition to diverticular disease was associated with the increased risks of colorectal cancer and colon cancer in the Finn-Gen population. In line with our findings, a populationbased and matched cohort study which included 389,184 participants found that patients with diverticular disease had an increased risk of colon cancer and the colorectal cancer risk increased mainly in the first year of followup [22]. A systematic review and meta-analysis of observational studies demonstrated the pool prevalence of colorectal cancer was 1.9% in the patients with acute diverticulitis and the risk of colorectal cancer was significantly higher in the patients with complicated diverticulitis [23].…”

Rho GTPase Activating Protein 15 (ARHGAP15) increases cancer risk in patients with diverticular disease

“…We conclude that ARHGAP15 could be responsible for the association of diverticular disease and cancer that Ma et al reported [1].…”

“…Ma et al studied cancer risk in diverticular disease and reported that patients with diverticular disease who have colorectal histopathology, normal or abnormal, have increased risk of overall incident cancer [1]. The cancers included colorectal cancer, lung cancer, pancreatic cancer, and liver cancer.…”

Colonic diverticulosis as an isolated colonoscopy finding for iFOBT-positive patients

“…However, Cooper et al reported an association between diverticulosis and increased risk of interval CRC within 6 months after a negative colonoscopy [17]. Ma et al provided the cohort study results with a linkage of diverticular disease with a risk of overall incident CRC [18]. Nakahara et al state that there is no statistical difference in the relationship between colon neoplasms and colonic diverticulosis within the screening program for positive FOBT patients [19].…”