Cancer risk in patients with diverticular disease: A nationwide cohort study

Abstract

Background: There are little data on diverticular disease and cancer development other than colorectal cancer.

Methods: We conducted a population-based, matched cohort study with linkage of nationwide registers to the Epidemiology Strengthened by histoPathology Reports in Sweden histopathology cohort. We included 75 704 patients with a diagnosis of diverticular disease and colorectal histopathology and 313 480 reference individuals from the general population matched on age, sex, calendar year, and county. Cox proportional hazards models estimated multivariable-adjusted hazard ratios (HRs) for associations between diverticular disease and overall cancer and specific cancers.

Results: Over a median follow-up of 6 years, we documented 12 846 incident cancers among patients with diverticular disease and 43 354 incident cancers among reference individuals from the general population. Compared with reference individuals, patients with diverticular disease had statistically significantly increased overall cancer incidence (24.5 vs 18.1 per 1000 person-years), equivalent to 1 extra cancer case in 16 individuals with diverticular disease followed-up for 10 years. After adjusting for covariates, having a diagnosis of diverticular disease was associated with a 33% increased risk of overall cancer (95% confidence interval [CI] = 1.31 to 1.36). The risk increases also persisted compared with siblings as secondary comparators (HR = 1.26, 95% CI = 1.21 to 1.32). Patients with diverticular disease also had an increased risk of specific cancers, including colon cancer (HR = 1.71, 95% CI = 1.60 to 1.82), liver cancer (HR = 1.72, 95% CI = 1.41 to 2.10), pancreatic cancer (HR = 1.62, 95% CI = 1.42 to 1.84), and lung cancer (HR = 1.50, 95% CI = 1.39 to 1.61). The increase in colorectal cancer risk was primarily restricted to the first year of follow-up, and especially early cancer stages.

Conclusions: Patients with diverticular disease who have colorectal histopathology have an increased risk of overall incident cancer.

Figure 1.

Kaplan-Meier curves (up to 15 years). Curves and hazard ratios (HRs) are unadjusted. Hazard ratios and 95% confidence intervals (CIs) during the first year of follow-up are shown in the black boxes.

Figure 2.

Risk of any cancer in patients with diverticular disease with inflammation or diverticula or normal histology and matched reference individuals from the general population. Models were stratified by matching pair and adjusted for education level and comorbidities, including cardiovascular disease, respiratory disease, inflammatory bowel disease, diabetes, chronic obstructive pulmonary disease, obesity, and alcohol-related disease. The error bars represent 95% confidence intervals.