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. 2020 Mar;122(6):912-917.
doi: 10.1038/s41416-019-0701-5. Epub 2020 Jan 13.

The association between colorectal cancer and prior antibiotic prescriptions: case control study

David Armstrong  1 , Alex Dregan  2 , Mark Ashworth  3 , Patrick White  3 , Chris McGee  4   5 , Simon de Lusignan  4   5
Affiliations

The association between colorectal cancer and prior antibiotic prescriptions: case control study

David Armstrong et al. Br J Cancer. 2020 Mar.

Abstract

Background: Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers.

Methods: A case control study used the RCGP's Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer.

Results: A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61-2.19, p < 0.001).

Conclusions: Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart describing the study sample selection.
Fig. 2
Fig. 2
Boxplot showing the number of antibiotic prescriptions, stratified by timing in relation to the index date.
Fig. 3
Fig. 3
Conditional logistic regression results for antibiotic prescriptions association with colorectal cancer risk.
Fig. 4
Fig. 4
Conditional logistic regression results for antibiotic types association with colorectal cancer risk.
See this image and copyright information in PMC

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