ASPO Abstracts
Helicobacter pylori eradication treatment is associated with a lower incidence of colorectal cancer, based on a nationwide cohort analysis
Category: Early Detection & Risk Prediction
Conference Year: 2023
Abstract Body:
Purpose: Helicobacter pylori (H. pylori), an established gastric carcinogen, is the most common cause of infection-associated cancer worldwide. Our primary objective was to evaluate the impact of H. pylori and H. pylori eradication treatment on colorectal cancer (CRC) incidence and mortality using the nationwide Veterans Health Administration cohort. Methods: We conducted a retrospective cohort study among adults who completed H. pylori testing between 10/1/1999 to 12/31/2018. The index date was the date of first H. pylori testing. Individuals were followed until the earliest of: incident or fatal CRC, non-CRC death, or 12/31/2019. We used multivariable Cox models (adjusted for age at H. pylori testing, sex, race and ethnicity, BMI, smoking status, and aspirin use prior to the index date) to estimate incident and fatal CRC hazard ratios (HR) and corresponding 95% confidence intervals (95% CI) for CRC based on H. pylori status (positive vs negative) and eradication treatment status (treated vs untreated). Results: Among 812,736 eligible individuals who completed H. pylori testing, 205,178 (25.2%) tested positive. Total follow-up time was 6,284,879 person-years. Compared to H. pylori negative individuals,H. pylori positive individuals had significantly higher 15-year CRC incidence (1.77% [95% CI 1.69%-1.85%] vs. 1.27% [95% CI 1.22%-1.32%]) and mortality (0.64% [95% CI 0.59%-0.69%] vs. 0.45% [95% CI 0.42%-0.48%]). Among H. pylori positive individuals, H. pylori treatment vs no treatment was associated with a significantly lower CRC incidence (1.44% [95% CI 1.34%-1.53%] vs. 1.82% [95% CI 1.68%-1.95%]) and mortality (0.57% [95% CI 0.51%-0.64%] vs. 0.78% [95% CI 0.68%-0.88%]) through 15 years follow-up. Individuals who were H. pylori positive had a significantly higher risk of incident (aHR, 1.18 [95% CI 1.12-1.24]) and fatal CRC (aHR 1.11 [95% CI 1.01-1.23]) compared to H. pylori negative individuals. Individuals with untreated vs treated H. pylori infection had a 23% (aHR, 1.23 [1.13-1.34]) and 37% (aHR 1.37 [1.17-1.61]) higher risk of incident and fatal CRC, respectively. Conclusions: H. pylori positivity is associated with a significantly higher incidence of CRC and related mortality, and eradication treatment compared to no treatment lowers this risk.
Keywords: colorectal neoplasia; screening and prevention; epidemiology