| Peer-Reviewed

Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study

Received: 29 June 2021     Accepted: 12 July 2021     Published: 10 September 2021
Views:       Downloads:
Abstract

Female sex hormonal supplementation had been shown to be protective against Colorectal cancer (CRC). Turner syndrome (TS) is a rare X lined chromosomal disorder associated with sex hormonal deficiency. Hence, we hypothesized that that females with TS would be at an increased risk of CRC. From the Truven Health Marketscan Commercial Claims and Encounters Database, female patients who had colonoscopy with TS were compared to aged matched to controls. For these patients we obtained demographic variables, risk factors (diabetes, morbid obesity, smoking, use of non-steroidal anti-inflammatory drugs and statins) and endoscopic results (adenoma and cancer detection) from the database. Multivariate logistic regression analysis was performed to compare the cancer detection rates in both groups. Of the 7,77,36,681 patients of age 35 or older in the database 3265 had TS. Of those 546 (17%) patients had a colonoscopy that was reported. These patients were compared to 1059 age matched controls. Prevalence of diabetes (14.3 vs 8.4, P<0.001), and smoking (2.6 vs 0.9, p=0.01) was higher in patients with TS. Cancer detection rate was higher in patients with TS (1.1% vs 0.2%, p=0.01). After adjustment for the above variables, patients with TS have an adjusted odds ratio of 9.5 for CRC at any colonoscopy (95% CI 1.7-52.8, p =0.008). Hence, we concluded that in the studied cohort of TS patients there was a higher colorectal cancer detection rate at any colonoscopy when compared to their age matched female counterparts. TS patients represent a ‘disparity group’ who warrant enhanced CRC screening.

Published in American Journal of Internal Medicine (Volume 9, Issue 5)
DOI 10.11648/j.ajim.20210905.11
Page(s) 219-224
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Colorectal Cancer, Turner Syndrome, Disparity Group, Case Control Study, Truven Marketscan Database

References
[1] Society, A. C. Cancer Facts & Figures 2020. American Cancer Society 2020 2020; Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf.
[2] Mauri, G., et al., Early-onset colorectal cancer in young individuals. Mol Oncol, 2019. 13 (2): p. 109-131.
[3] Yurgelun, M. B., et al., Cancer Susceptibility Gene Mutations in Individuals With Colorectal Cancer. J Clin Oncol, 2017. 35 (10): p. 1086-1095.
[4] Stoffel, E. M., et al., Germline Genetic Features of Young Individuals With Colorectal Cancer. Gastroenterology, 2018. 154 (4): p. 897-905 e1.
[5] Rex, D. K., et al., Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol, 2017. 112 (7): p. 1016-1030.
[6] Abotchie, P. N., S. W. Vernon, and X. L. Du, Gender differences in colorectal cancer incidence in the United States, 1975-2006. J Womens Health (Larchmt), 2012. 21 (4): p. 393-400.
[7] Cui, X., et al., A basic understanding of Turner syndrome: Incidence, complications, diagnosis, and treatment. Intractable Rare Dis Res, 2018. 7 (4): p. 223-228.
[8] Wernli, K. J., et al., The relationship between gravidity and parity and colorectal cancer risk. J Womens Health (Larchmt), 2009. 18 (7): p. 995-1001.
[9] Fernandez, E., et al., Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer, 2001. 84 (5): p. 722-7.
[10] Grodstein, F., P. A. Newcomb, and M. J. Stampfer, Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med, 1999. 106 (5): p. 574-82.
[11] Hasle, H., et al., Occurrence of cancer in women with Turner syndrome. Br J Cancer, 1996. 73 (9): p. 1156-9.
[12] Ji, J., et al., Risk of solid tumors and hematological malignancy in persons with Turner and Klinefelter syndromes: A national cohort study. Int J Cancer, 2016. 139 (4): p. 754-8.
[13] Schoemaker, M. J., et al., Cancer incidence in women with Turner syndrome in Great Britain: a national cohort study. Lancet Oncol, 2008. 9 (3): p. 239-46.
[14] Kulaylat, A. S., et al., Truven Health Analytics MarketScan Databases for Clinical Research in Colon and Rectal Surgery. Clin Colon Rectal Surg, 2019. 32 (1): p. 54-60.
[15] Huo, J., M. Yang, and Y. C. Tina Shih, Sensitivity of Claims-Based Algorithms to Ascertain Smoking Status More Than Doubled with Meaningful Use. Value Health, 2018. 21 (3): p. 334-340.
[16] Spyropoulos, A. C., et al., Rivaroxaban versus warfarin treatment among morbidly obese patients with venous thromboembolism: Comparative effectiveness, safety, and costs. Thromb Res, 2019. 182: p. 159-166.
[17] Klein, K. O., et al., Estrogen Replacement in Turner Syndrome: Literature Review and Practical Considerations. J Clin Endocrinol Metab, 2018. 103 (5): p. 1790-1803.
[18] Abir, R., et al., Turner's syndrome and fertility: current status and possible putative prospects. Hum Reprod Update, 2001. 7 (6): p. 603-10.
[19] Caiazza, F., et al., Estrogen receptors and their implications in colorectal carcinogenesis. Front Oncol, 2015. 5: p. 19.
[20] Saleiro, D., et al., Estrogen receptor-beta protects against colitis-associated neoplasia in mice. Int J Cancer, 2012. 131 (11): p. 2553-61.
[21] Rudolph, A., et al., Expression of oestrogen receptor beta and prognosis of colorectal cancer. Br J Cancer, 2012. 107 (5): p. 831-9.
[22] Chlebowski, R. T., et al., Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med, 2004. 350 (10): p. 991-1004.
[23] Roos, V. H., et al., Effects of Family History on Relative and Absolute Risks for Colorectal Cancer: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol, 2019. 17 (13): p. 2657-2667 e9.
[24] Leddin, D., et al., Clinical Practice Guideline on Screening for Colorectal Cancer in Individuals With a Family History of Nonhereditary Colorectal Cancer or Adenoma: The Canadian Association of Gastroenterology Banff Consensus. Gastroenterology, 2018. 155 (5): p. 1325-1347 e3.
[25] Gravholt, C. H., et al., Morbidity in Turner syndrome. J Clin Epidemiol, 1998. 51 (2): p. 147-58.
[26] Yuhara, H., et al., Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol, 2011. 106 (11): p. 1911-21; quiz 1922.
[27] Karahalios, A., D. R. English, and J. A. Simpson, Weight change and risk of colorectal cancer: a systematic review and meta-analysis. Am J Epidemiol, 2015. 181 (11): p. 832-45.
[28] Botteri, E., et al., Smoking and colorectal cancer: a meta-analysis. JAMA, 2008. 300 (23): p. 2765-78.
[29] Lindgren, G., et al., Adenoma prevalence and cancer risk in familial non-polyposis colorectal cancer. Gut, 2002. 50 (2): p. 228-34.
[30] Bui, Q. M., D. Lin, and W. Ho, Approach to Lynch Syndrome for the Gastroenterologist. Dig Dis Sci, 2017. 62 (2): p. 299-304.
[31] Carethers, J. M. and E. M. Stoffel, Lynch syndrome and Lynch syndrome mimics: The growing complex landscape of hereditary colon cancer. World J Gastroenterol, 2015. 21 (31): p. 9253-61.
[32] Lynch, H. T., J. F. Lynch, and T. A. Attard, Diagnosis and management of hereditary colorectal cancer syndromes: Lynch syndrome as a model. CMAJ, 2009. 181 (5): p. 273-80.
[33] Slattery, M. L., et al., Estrogens reduce and withdrawal of estrogens increase risk of microsatellite instability-positive colon cancer. Cancer Res, 2001. 61 (1): p. 126-30.
Cite This Article
  • APA Style

    Venkata Subhash Gorrepati, Djibril M. Ba, Guodong Liu, John Levenick, Thomas McGarrity. (2021). Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study. American Journal of Internal Medicine, 9(5), 219-224. https://doi.org/10.11648/j.ajim.20210905.11

    Copy | Download

    ACS Style

    Venkata Subhash Gorrepati; Djibril M. Ba; Guodong Liu; John Levenick; Thomas McGarrity. Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study. Am. J. Intern. Med. 2021, 9(5), 219-224. doi: 10.11648/j.ajim.20210905.11

    Copy | Download

    AMA Style

    Venkata Subhash Gorrepati, Djibril M. Ba, Guodong Liu, John Levenick, Thomas McGarrity. Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study. Am J Intern Med. 2021;9(5):219-224. doi: 10.11648/j.ajim.20210905.11

    Copy | Download

  • @article{10.11648/j.ajim.20210905.11,
      author = {Venkata Subhash Gorrepati and Djibril M. Ba and Guodong Liu and John Levenick and Thomas McGarrity},
      title = {Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study},
      journal = {American Journal of Internal Medicine},
      volume = {9},
      number = {5},
      pages = {219-224},
      doi = {10.11648/j.ajim.20210905.11},
      url = {https://doi.org/10.11648/j.ajim.20210905.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210905.11},
      abstract = {Female sex hormonal supplementation had been shown to be protective against Colorectal cancer (CRC). Turner syndrome (TS) is a rare X lined chromosomal disorder associated with sex hormonal deficiency. Hence, we hypothesized that that females with TS would be at an increased risk of CRC. From the Truven Health Marketscan Commercial Claims and Encounters Database, female patients who had colonoscopy with TS were compared to aged matched to controls. For these patients we obtained demographic variables, risk factors (diabetes, morbid obesity, smoking, use of non-steroidal anti-inflammatory drugs and statins) and endoscopic results (adenoma and cancer detection) from the database. Multivariate logistic regression analysis was performed to compare the cancer detection rates in both groups. Of the 7,77,36,681 patients of age 35 or older in the database 3265 had TS. Of those 546 (17%) patients had a colonoscopy that was reported. These patients were compared to 1059 age matched controls. Prevalence of diabetes (14.3 vs 8.4, P<0.001), and smoking (2.6 vs 0.9, p=0.01) was higher in patients with TS. Cancer detection rate was higher in patients with TS (1.1% vs 0.2%, p=0.01). After adjustment for the above variables, patients with TS have an adjusted odds ratio of 9.5 for CRC at any colonoscopy (95% CI 1.7-52.8, p =0.008). Hence, we concluded that in the studied cohort of TS patients there was a higher colorectal cancer detection rate at any colonoscopy when compared to their age matched female counterparts. TS patients represent a ‘disparity group’ who warrant enhanced CRC screening.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study
    AU  - Venkata Subhash Gorrepati
    AU  - Djibril M. Ba
    AU  - Guodong Liu
    AU  - John Levenick
    AU  - Thomas McGarrity
    Y1  - 2021/09/10
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajim.20210905.11
    DO  - 10.11648/j.ajim.20210905.11
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 219
    EP  - 224
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20210905.11
    AB  - Female sex hormonal supplementation had been shown to be protective against Colorectal cancer (CRC). Turner syndrome (TS) is a rare X lined chromosomal disorder associated with sex hormonal deficiency. Hence, we hypothesized that that females with TS would be at an increased risk of CRC. From the Truven Health Marketscan Commercial Claims and Encounters Database, female patients who had colonoscopy with TS were compared to aged matched to controls. For these patients we obtained demographic variables, risk factors (diabetes, morbid obesity, smoking, use of non-steroidal anti-inflammatory drugs and statins) and endoscopic results (adenoma and cancer detection) from the database. Multivariate logistic regression analysis was performed to compare the cancer detection rates in both groups. Of the 7,77,36,681 patients of age 35 or older in the database 3265 had TS. Of those 546 (17%) patients had a colonoscopy that was reported. These patients were compared to 1059 age matched controls. Prevalence of diabetes (14.3 vs 8.4, P<0.001), and smoking (2.6 vs 0.9, p=0.01) was higher in patients with TS. Cancer detection rate was higher in patients with TS (1.1% vs 0.2%, p=0.01). After adjustment for the above variables, patients with TS have an adjusted odds ratio of 9.5 for CRC at any colonoscopy (95% CI 1.7-52.8, p =0.008). Hence, we concluded that in the studied cohort of TS patients there was a higher colorectal cancer detection rate at any colonoscopy when compared to their age matched female counterparts. TS patients represent a ‘disparity group’ who warrant enhanced CRC screening.
    VL  - 9
    IS  - 5
    ER  - 

    Copy | Download

Author Information
  • Department of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, USA

  • Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, USA

  • Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, USA

  • Department of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, USA

  • Department of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, USA

  • Sections