Microscopic colitis and risk of cancer - a population-based cohort study

David Bergman; Hamed Khalili; Bjorn Roelstraete; Jonas F Ludvigsson

doi:10.1093/ecco-jcc/jjaa156

Microscopic colitis and risk of cancer - a population-based cohort study

J Crohns Colitis. 2020 Jul 25:jjaa156. doi: 10.1093/ecco-jcc/jjaa156. Online ahead of print.

Authors

David Bergman¹, Hamed Khalili^{2

3}, Bjorn Roelstraete¹, Jonas F Ludvigsson^{1

4

5

6}

Affiliations

¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
² Massachusetts General Hospital, Crohn's and Colitis Center and Harvard Medical School, Boston, MA.
³ Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.
⁵ Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK.
⁶ Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.

PMID: 32710780
DOI: 10.1093/ecco-jcc/jjaa156

Abstract

Background and aims: The association between microscopic colitis (MC) and cancer risk is unclear. Large, population-based studies are lacking.

Methods: We conducted a nationwide cohort study of 11,758 patients with incident MC (diagnosed 1990-2016 in Sweden), 50,828 matched reference individuals and 11,614 siblings to MC patients. Data were obtained through Sweden´s pathology departments and from the Swedish Cancer Register. Adjusted hazard ratios (aHRs) were calculated using Cox proportional hazards models.

Results: At the end of follow up (mean: 6.7 years), 1,239 (10.5%) of MC patients had received a cancer diagnosis, compared to 4,815 (9.5%) of reference individuals (aHR 1.08 (95%CI=1.02-1.16)). The risk of cancer was highest during the first year of follow up. The absolute excess risks for cancer at 5, 10 and 20 years after MC diagnosis were +1.0% (95%CI=0.4%-1.6%), +1.5% (0.4%-2.6%) and +3.7% (-2.3-9.6%), respectively, equivalent to one extra cancer event in every 55 individuals with MC followed for ten years.MC was associated with an increased risk of lymphoma (aHR 1.43, 1.06-1.92) and lung cancer (aHR 1.32, 1.04-1.68) but with decreased risks of colorectal (aHR 0.52, 0.40-0.66) and gastrointestinal cancers (aHR 0.72, 0.60-0.85). We found no association with breast or bladder cancer. Using siblings as reference group to minimize the impact of shared genetic and early environmental factors, patients with MC were still at an increased risk of cancer (HR=1.20; 95%CI=1.06-1.36).

Conclusions: This nationwide cohort study demonstrated an 8% increased risk of cancer in MC patients. The risk was highest during the first year of follow up.

Keywords: Microscopic colitis; cancer; epidemiology.