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Risk for Colorectal Adenocarcinoma in Pernicious Anemia: A Population-Based Cohort Study

Nicholas J. Talley, MB, PhD; Christopher G. Chute, MD; David E. Larson, MD; Robert Epstein, MD, MS; Eva G. Lydick, PhD; and L. Joseph Melton III, MD
[+] Article and Author Information

Grant Support: Supported in part by research grant AM-30582 from the National Institutes of Health, U.S. Public Health Service, and by a grant from Merck, Sharp and Dohme.

Requests for Reprints: Nicholas J. Talley, MB, PhD, Gastroenterology Research Unit, Mayo Clinic, Rochester, MN 55905.

Current Author Addresses: Drs. Talley and Larson, Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905.

Drs. Chute and Melton: Clinical Epidemiology, Mayo Clinic, Rochester, MN 55905.

Drs. Epstein and Lydick: Merck, Sharp and Dohme Research Laboratory, Division of Merck & Company, Inc. , West Point, PA 19486.


© 1989 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1989;111(9):738-742. doi:10.7326/0003-4819-111-9-738
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Study Objective: To determine the long-term risk for colorectal cancer among patients with pernicious anemia.

Design: Historical cohort study.

Setting: Population-based inception cohort of Rochester, Minnesota, residents.

Patients and Methods: We identified 150 Rochester residents who had the onset of pernicious anemia during the 30-year period from 1950 through 1979, and we followed this cohort for 1664 person-years of observation. The observed risk for subsequent colorectal cancer in this cohort was compared with that expected based on incidence rates of colon and rectal cancer for the local population.

Measurements and Main Results: There were 14 cases of colorectal cancer among the 150 patients with pernicious anemia (where 10.5 cases were expected), and 9 of these cases were found after the diagnosis of pernicious anemia was established (where 5.1 cases were expected). The relative risk for colon cancer at any time after the diagnosis of pernicious anemia was 1.8 (CI, 0.8 to 3.3). The relative risk was greatest (4.1; CI, 1.7 to 8.7) in the 5-year period immediately after the diagnosis of pernicious anemia; during this period, 7 cases of colon cancers were observed but only 1.7 were expected (P < 0.0001).

Conclusion: Although the overall risk does not achieve statistical significance, patients with pernicious anemia may have an increased risk for colorectal adenocarcinoma in the 5 years after diagnosis.

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