Colorectal Cancer: Constipation Link, New Colonoscopy Guidelines

Patients who have chronic constipation may be at increased risk for colorectal cancer and benign neoplasms, researchers reported at the American College of Gastroenterology (ACG) 77th Annual Scientific Meeting in Las Vegas. In addition, new colonoscopy surveillance guidelines have been issued.

In the study, “Risk of Developing Colorectal Cancer and Benign Neoplasm in Patients with Chronic Constipation,” the researchers investigated the prevalence and incidence of colorectal cancer and benign neoplasms in 28,854 patients 18 years or older who had chronic constipation and 86,562 controls who did not; they were identified from a large retrospective US claims data base. The findings included the following:

• Both colorectal cancer and benign neoplasms are more prevalent in patients who have chronic constipation than in those who do not.

• Among patients who did not have a previous diagnosis of colorectal cancer or benign neoplasms before their index date, and after controlling for potential confounding factors (eg, age, sex, family history of malignancies, and other non-GI comorbidities), those who have chronic constipation are at greater risk for colorectal cancer or benign neoplasms.

• The risk of colorectal cancer is 1.78 times higher and the risk of benign neoplasms is 2.70 times higher in patients who have chronic constipation than in those who do not.

Rather than causation, the study demonstrates an association between chronic constipation and both colorectal cancer and benign neoplasms, the investigators noted. Chronic constipation is considered a somewhat benign disease, but clinicians should be aware of the potential association to monitor patients and treat them accordingly.

The newly issued screening guidelines recommend colonoscopy as a “preferred” colorectal cancer prevention strategy beginning at age 50 years (age 45 years for African Americans.) “Guidelines for Colonoscopy Surveillance After Screening and Polypectomy,” a consensus update issued by the US Multisociety Task Force on Colorectal Cancer-including representatives of the ACG, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy-offers several practical cancer prevention recommendations.