Article
No association between colon cancer and adenocarcinoma of the
oesophagus in a population based cohort study in Sweden
J Lagergrena b, O Nyrena
a Department of
Medical Epidemiology, Karolinska Institute, Box 281, S-171 77 Stockholm, Sweden, b Division of Surgery, Karolinska Institutet
Danderyd Hospital, Stockholm, Sweden
Correspondence to: Dr Lagergren.
Accepted for publication 6 January 1999
BACKGROUND
Previous reports have
indicated an association between Barrett's metaplasia or
adenocarcinoma of the oesophagus and colonic neoplasia, but the
findings have been inconsistent. If true, such an association suggests
common causal mechanisms.
AIMSTo test the hypothesis of an
association between Barrett's metaplasia or adenocarcinoma of the
oesophagus and colonic neoplasia.
METHODSA population based,
retrospective cohort study was performed on all Swedish patients with
colon cancer diagnosed between 1958 and 1992. 538 500 person years at
risk were reviewed among the 118 030 patients in the cohort (average
follow up 4.6 years, median 2.1 years). The standardised incidence
ratio (SIR), the ratio of the observed to the expected number of
incident oesophageal adenocarcinomas, was used as a measure of relative
risk. The expected number was derived from the entire Swedish population.
RESULTSEleven oesophageal
adenocarcinomas were found during follow up in the cohort, as against
9.5 expected (SIR=1.2; 95% confidence interval 0.6-2.1). Analysis by
latency intervals after diagnosis of colon cancer showed no trend
towards increasing or decreasing risk over time. There were no
important sex differences in relative risk.
CONCLUSIONSResults provide no
support for a common link between colon cancer and oesophageal
adenocarcinoma. Although the direct relation between colon cancer and
Barrett's oesophagus was not looked at, a search for common
aetiological factors or genetic defects may not be fruitful. Screening
for colonic neoplasia among patients with malignant or premalignant
oesophageal mucosa, or vice versa, may not be warranted.
Keywords: oesophageal cancer; Barrett's metaplasia; colon cancer; adenocarcinoma
© 1999 by Gut
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