Diverticular disease and cancer risk: More than a gut feeling
Veronika Fedirko et al.
Diverticular disease of the colon is among the most common gastrointestinal disorders in Western countries. It is a clinically significant and symptomatic diverticulosis, which is defined by the presence of a pouch-like protrusion of the colonic wall known as diverticula. Diverticular disease could present itself as diverticular bleeding, perforation, colitis, inflammation, or as abdominal pain, and generally is regarded as a very heterogenous disease. Given its relatively high prevalence (over 50% by age 60 by some estimates) 1 and need for a medical intervention, it is a significant contributor to healthcare costs and hospital admissions. The study by Ma et al.published in the current edition of the journal provides new information about cancer risk among patients with diverticular disease. In the Swedish population-based study of 75,704 individuals with a diagnosis of diverticular disease and colorectal histopathology, and 313,480 reference individuals from the general population, having a diagnosis of diverticular disease was associated with a 33% increased risk of overall cancer. Persons with diverticular disease also had higher risk of specific cancers, including cancers of the colon (HR=1.71; 95% CI=1.60-1.82), liver (HR=1.72; 95% CI=1.41-2.10), pancreas (HR=1.62; 95% CI=1.42-1.84), and the lung (HR=1.50; 95% CI=1.39-1.61). While the association with colorectal cancer has been previously described3-6 and could in part be attributed to misclassification of undiagnosed cancer as diverticular disease or to additional follow-up tests, there was another intriguing finding. Individuals with diverticular disease had a lower risk of rectal cancer (HR=0.87; 95% CI=0.79-0.97) compared to reference individuals. This was an interesting observation especially considering that the occurrence of diverticula in the rectum is rare. One might postulate that the lower risk could be due, at least in part, to exclusion of patients with concomitant undiagnosed diverticular disease and rectal cancer from the study and/or more effective removal of pre-cancerous lesions in the rectum (versus in other parts of the colon affected by diverticular disease) during an initial diagnostic colonoscopy.
LEGGI TUTTO https://pubmed.ncbi.nlm.nih.gov/36200895/#:~:text=DOI%3A-,10.1093/jnci/djac191,-No%20abstract%20available
