Risk of colorectal cancer in patients with diabetes mellitus: A Swedish nationwide cohort study

Abstract

Background Colorectal cancer (CRC) incidence is increasing among young adults below screening age, despite the effectiveness of screening in older populations. Individuals with diabetes mellitus are at increased risk of early-onset CRC. We aimed to determine how many years earlier than the general population patients with diabetes with/without family history of CRC reach the threshold risk at which CRC screening is recommended to the general population. Methods and findings A nationwide cohort study (follow-up:1964–2015) involving all Swedish residents born after 1931 and their parents was carried out using record linkage of Swedish Population Register, Cancer Registry, National Patient Register, and Multi-Generation Register. Of 12,614,256 individuals who were followed between 1964 and 2015 (51% men; age range at baseline 0–107 years), 162,226 developed CRC, and 559,375 developed diabetes. Age-specific 10-year cumulative risk curves were used to draw conclusions about how many years earlier patients with diabetes reach the 10-year cumulative risks of CRC in 50-year-old men and women (most common age of first screening), which were 0.44% and 0.41%, respectively. Diabetic patients attained the screening level of CRC risk earlier than the general Swedish population. Men with diabetes reached 0.44% risk at age 45 (5 years earlier than the recommended age of screening). In women with diabetes, the risk advancement was 4 years. Risk was more pronounced for those with additional family history of CRC (12–21 years earlier depending on sex and benchmark starting age of screening). The study limitations include lack of detailed information on diabetes type, lifestyle factors, and colonoscopy data. Conclusions Using high-quality registers, this study is, to our knowledge, the first one that provides novel evidence-based information for risk-adapted starting ages of CRC screening for patients with diabetes, who are at higher risk of early-onset CRC than the general population.

Young-onset colorectal cancer: A review

“…Although CRC mortality rates have decreased among older adults, mortality among those under 50 appears to be gradually increasing, with an estimated 1.9 deaths per 100000 as of 2018[ 4 ]. International trends mirror these aforementioned US trends and have been reported across the West, including Canada, the United Kingdom, Sweden, Switzerland, Italy, as well as Australia, Egypt, and in Asia[ 2 , 9 - 13 ].…”

“…A birth cohort effect occurs when age-specific incidence rates vary by age group due to a change in exposure (behavioral, cultural, lifestyle, and environmental factors) that influences disease risk[ 8 , 26 ]. Obesity, diabetes, lack of physical activity, heavy alcohol consumption, and a typical “Western” diet (rich in fast food, processed and red meat, and poor intake of vegetables and fruits), are associated with increased risk of CRC[ 1 , 9 , 10 , 27 - 35 ]. The prevalence of obesity has increased in the United States, and there is evidence of an association between obesity and risk of developing CRC prior to age 50.…”

“…The prevalence of obesity has increased in the United States, and there is evidence of an association between obesity and risk of developing CRC prior to age 50. A national longitudinal study evaluating 12.6 million Swedish residents between 1964 to 2015 to investigate how many years earlier patients with diabetes reach the 10-year cumulative risks of CRC as a 50 years old man or woman without diabetes demonstrated that diabetic patients attained the screening level of CRC risk 5 years earlier[ 9 ]. Sedentary behavior has increased as a result of a greater number of desk-bound work hours and passive media consumption, and there is evidence that sedentary behavior independently increases risk for young-onset CRC after adjusting for the effects of obesity and physical activity[ 36 ].…”

Patient-Level Cancer Prediction Models From a Nationwide Patient Cohort: Model Development and Validation

“…One study aimed to predict heart failure from EHR data [27], and others focused on diabetes development [28][29][30] or hypertension [31,32]. Furthermore, a few studies have used nationwide claim health checkup data to create a cancer prediction model [33][34][35][36]. To solve the overdiagnosis problem of cancer screening programs resulting in unnecessary intervention, accurate, easy-to-implement, patient-level models should be developed.…”

Excess Body Weight and Gastrointestinal Cancer Risk

“…Novel evidence argues for risk-adapted starting ages for CRC screening among patients with (type 2) diabetes and EBW. People with combined risk factors, such as family history plus type 2 diabetes/EBW, face a far higher risk of early-onset CRC than the average population [16].…”