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Normal gastrointestinal mucosa at biopsy and subsequent cancer risk: nationwide population-based, sibling-controlled cohort study
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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2022 (English)In: BMC Cancer, E-ISSN 1471-2407, Vol. 22, no 1, article id 890Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While individuals with normal gastrointestinal (GI) mucosa on endoscopy have a lower risk of colorectal cancer, risks of other cancers remain unexplored.

METHODS: Through Sweden's 28 pathology departments, we identified 415,092 individuals with a first GI biopsy with histologically normal mucosa during 1965-2016 and no prior cancer. These individuals were compared to 1,939,215 matched reference individuals from the general population. Follow-up began 6 months after biopsy, and incident cancer data were retrieved from the Swedish Cancer Register. Flexible parametric model was applied to estimate cumulative incidences and hazard ratios (HRs) for cancers. We also used full siblings (n = 441,534) as a secondary comparison group.

RESULTS: During a median follow-up of 10.9 years, 40,935 individuals with normal mucosa (incidence rate: 82.74 per 10,000 person-years) and 177,350 reference individuals (incidence rate: 75.26) developed cancer. Restricting the data to individuals where follow-up revealed no cancer in the first 6 months, we still observed an increased risk of any cancer in those with a histologically normal mucosa (average HR = 1.07; 95%CI = 1.06-1.09). Although the HR for any and specific cancers decreased shortly after biopsy, we observed a long-term excess risk of any cancer, with an HR of 1.08 (95%CI = 1.05-1.12) and a cumulative incidence difference of 0.93% (95%CI = 0.61%-1.25%) at 30 years after biopsy. An elevated risk of gastric cancer, lung cancer, and hematological malignancy (including lymphoproliferative malignancy) was also observed at 20 or 30 years since biopsy. Sibling analyses confirmed the above findings.

CONCLUSION: Individuals with a histologically normal mucosa at biopsy and where follow-up revealed no cancer in the first 6 months, may still be at increased risk of cancer, although excess risks are small.

Place, publisher, year, edition, pages
BioMed Central, 2022. Vol. 22, no 1, article id 890
Keywords [en]
Cancer, Cohort, Gastrointestinal, Histology, Normal mucosa, Screening
National Category
Cancer and Oncology Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-100664DOI: 10.1186/s12885-022-09992-5ISI: 000840322400003PubMedID: 35964121Scopus ID: 2-s2.0-85135934104OAI: oai:DiVA.org:oru-100664DiVA, id: diva2:1687655
Funder
Karolinska InstituteSwedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareSwedish Cancer Society
Note

Funding agency:

China Scholarship Council

Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2025-02-11Bibliographically approved

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Halfvarson, JonasLudvigsson, Jonas F.

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