Rural-urban differences in the long-term risk of colorectal cancer after adenoma removal: a population-based study.
Fiche publication
Date publication
avril 2014
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BINQUET Christine, Dr BOUVIER Anne-Marie, Dr FOURNEL Isabelle, Dr JOOSTE Valérie, Dr COTTET Vanessa
Tous les auteurs :
Fournel I, Cottet V, Binquet C, Jooste V, Faivre J, Bouvier AM, Bonithon-Kopp C
Lien Pubmed
Résumé
BACKGROUND: We investigated the impact of municipality of residence on colonoscopic surveillance and colorectal cancer risk after adenoma resection in a French well-defined administrative area. METHODS: This registry-based study included all patients residing in Cote d'Or (n=5769) first diagnosed with colorectal adenomas between January 1, 1990, and December 31, 1999. Information about colonoscopic surveillance and colorectal cancer incidence was collected until December 31, 2003. RESULTS: A rural place of residence reduced the probability of colonoscopic surveillance in men [HR=0.89 (95%CI: 0.79-0.99), p=0.041] and in patients without family history of colorectal cancer [HR=0.91(0.82-0.99), p=0.044]. After a median follow-up of 7.7 years, 87 patients developed invasive colorectal cancer. After advanced adenoma removal, the standardized incidence ratio for colorectal cancer was 3.03 (95%CI: 1.92-4.54) for rural patients and 1.87 (95%CI: 1.26-2.66) for urban patients compared with the general population. The risk of colorectal cancer was higher in rural patients than in urban ones only after removal of the initial advanced adenoma [HR=1.73 (95%CI: 1.01-3.00, p=0.048)]. Further adjustment for surveillance colonoscopy, physician location, and other confounders had little impact on these results. CONCLUSION: The increased risk of subsequent colorectal cancer after advanced adenoma removal in French rural patients was not explained by a lower rate of colonoscopic surveillance. The role of socio-economic and environmental factors requires further exploration.
Référence
Dig Liver Dis. 2014 Apr;46(4):376-82