medwireNews: Helicobacter pylori infection is associated with an increased risk for colorectal cancer (CRC) incidence and mortality, but treatment for the infection can mitigate the risk, report researchers in the Journal of Clinical Oncology.
The authors of an accompanying editorial say that “[o]verall, it has generally been found that H. pylori eradication treatment is a highly feasible, cost-effective, and beneficial approach as a gastric cancer interception strategy—if it also intercepts colorectal cancer, even in a minority of cases, this only strengthens the cancer prevention impact.”
Julia Butt (German Cancer Research Center, Heidelberg) and Meira Epplein (Duke Cancer Institute, Durham, North Carolina, USA) continue: “Defining high-risk groups for test-and-treat approaches and surveilling to determine successful eradication could help overcome the harms of unnecessary antibiotic treatments and reduce antibiotic resistance to finally make use of an effective option to prevent gastric cancer and—supported by the gained knowledge from this study—colorectal cancer, as well as potentially also other diseases yet to be elucidated.”
The research team analyzed data from the US Veterans Health Administration on 812,736 individuals aged a median of 60 years who underwent testing for H. pylori between 1999 and 2018. The large majority were men (91.3%) and just under two-thirds (64.4%) were non-Hispanic White.
A total of 25.2% of the participants tested positive for H. pylori, while the remaining 74.8% were negative. Of those positive for H. pylori, 65.9% received treatment and 31.9% did not.
Shailja Shah (University of California San Diego, USA) and co-investigators found that the cumulative incidence of CRC and fatal CRC at 5, 10, and 15 years was significantly higher among individuals who did versus did not test positive for H. pylori.
And among those who were positive, H. pylori treatment was associated with significantly lower cumulative rates of CRC and fatal CRC at each timepoint, they add.
Multivariable analyses backed up these findings, showing a significant association between H. pylori positivity and incident and fatal CRC, with hazard ratios (HRs) relative to H. pylori negativity of 1.18 and 1.12, respectively, after adjusting for age, sex, race, ethnicity, aspirin use, and smoking status.
Similarly, among H. pylori-positive individuals, no treatment for H. pylori was significantly associated with an increased risk for incident and fatal CRC versus treatment, with respective adjusted HRs of 1.23 and 1.40.
Shah and colleagues also conducted sensitivity analyses which “confirmed that exposure to colonoscopy did not abrogate the association nor did removing individuals diagnosed with CRC within 1 year of study entry or considering non-CRC death as a competing risk,” further supporting the robustness of the results.
And they conclude: “While our data, supported by mechanistic studies, are compelling, more studies are needed to confirm the strength and consistency of these associations.
“In the interim, on the basis of the data presented herein, we posit that testing and treating for H. pylori may reduce the risk not only for gastric cancer but also for CRC.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group
J Clin Oncol 2024; doi:10.1200/JCO.23.00703
J Clin Oncol 2024; doi:10.1200/JCO.24.00019