Skip to main content
SpringerLink
Log in

Diverticulosis and the Risk of Interval Colorectal Cancer

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Diverticulosis, a prevalent condition at screening colonoscopy, has been associated with colorectal cancers that develop after a clearing colonoscopy, or interval cancers.

Aims

To quantify the overall risk of diverticulosis in the development of interval cancers and examine this association in relevant subgroups.

Methods

Using a linked database containing SEER tumor registry data and Medicare claims, we identified patients aged ≥69 years with colorectal cancer who underwent colonoscopy within 6 months of diagnosis. Patients with an additional colonoscopy from 36 to 6 months prior to cancer diagnosis were characterized as having interval cancers. We compared characteristics of patients with interval cancers and detected cancers according to a diagnosis of diverticulosis not associated with a colonoscopy procedure from 1991 through the date of the most recent colonoscopy in both univariate and multivariate models.

Results

A previous diagnosis of diverticulosis was documented in 14,452 (26.9 %) patients with detected cancers compared to 2,905 (69.3 %) patients with interval cancers (p < 0.001); these results were consistent in multivariable analysis. Moreover, the association was found as well in the proximal colon (OR 2.88, 95 % CI 2.66, 3.12), distal colon (OR 3.56, 95 % CI 3.09, 4.11), and rectum (OR 4.07, 95 % CI 3.34, 4.95). The vast majority of diverticulosis diagnoses were without complications such as hemorrhage or diverticulitis.

Conclusions

Diverticulosis was strongly associated with interval colorectal cancers in all segments of the colon. Given its known predominance in the left colon, the findings argue against impaired visualization of lesions at colonoscopy as the only pathogenic factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Haseman JH, Lemmel GT, Rahmani EY, Rex DK. Failure of colonoscopy to detect colorectal cancer. Gastrointest Endosc. 1997;45:451–455.

    Article  PubMed  CAS  Google Scholar 

  2. Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005;61:385–391.

    Article  PubMed  Google Scholar 

  3. Robertson DJ, Greenberg ER, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41.

    Article  PubMed  Google Scholar 

  4. Cooper GS, Xu F, Barnholtz Sloan JS, Schluchter MD, Koroukian SM. Prevalence and predictors of interval colorectal cancers in Medicare beneficiaries. Cancer. 2012;118:3044–3052.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Samadder NJ, Curtin K, Tuohy TMF, et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology. 2014;146:950–960.

    Article  PubMed  Google Scholar 

  6. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.

    Article  PubMed  Google Scholar 

  7. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination. JAMA. 2006;295:2366–2373.

    Article  PubMed  CAS  Google Scholar 

  8. Singh H, Nugent Z, Mahmud SM, et al. Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol. 2010;105:663–673.

    Article  PubMed  Google Scholar 

  9. Singh H, Nugent Z, Demers AA, Demers AA, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128–1137.

    Article  PubMed  Google Scholar 

  10. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology. 2007;132:96–102.

    Article  PubMed  Google Scholar 

  11. Singh H, Nugent Z, Demers A, Bernstein CN. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol. 2010;105:2588–2596.

    Article  PubMed  Google Scholar 

  12. Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Hang U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: a population-based study. J Natl Cancer Inst. 2010;102:89–95.

    Article  PubMed  Google Scholar 

  13. Patel SG, Ahnen DJ. Prevention of interval colorectal cancers: what every clinician needs to know. Clin Gastroenterol Hepatol. 2014;12:7–15.

    Article  PubMed  Google Scholar 

  14. Potosky AL, Riley GF, Lubitz JD, Mentnech RM, Kessler LG. Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care. 1993;31:732–748.

    Article  PubMed  CAS  Google Scholar 

  15. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF: Overview of the SEER-Medicare data. Med Care 2002; 40:IV-3-IV-18.

  16. Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–S28.

    Article  PubMed  Google Scholar 

  17. Francis DL, Rodriguez-Correa DT, Buchner A, Harewood GC, Wallace M. Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate. Gastrointest Endosc. 2011;73:493–497.

    Article  PubMed  Google Scholar 

  18. Williams JE, Le TD, Faigel DO. Polypectomy rate as a quality measure for colonoscopy. Gastrointest Endosc. 2011;73:498–506.

    Article  PubMed  Google Scholar 

  19. Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data. Med Care. 2002;40:26–35.

    Article  Google Scholar 

  20. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009–1013.

    PubMed  CAS  Google Scholar 

  21. Brenner H, Hoffmeister M, Stegmaier C, Altenhofer L, Haug U. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 810,149 screening colonoscopies. Gut. 2007;56:1585–1589.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Baker SR, Alterman DD. False-negative barium enema in patients with sigmoid cancer and diverticulosis. Gastrointest Radiol. 1985;10:171–173.

    Article  PubMed  CAS  Google Scholar 

  23. Martel J, Raskin JB. History, incidence and epidemiology of diverticulosis. J Clin Gastroenterol. 2008;42:1125–1127.

    Article  PubMed  Google Scholar 

  24. Kieff BJ, Eckert GJ, Imperiale TF. Is diverticulosis associated with colorectal neoplasia? A cross-sectional colonoscopic study. Am J Gastroenterol. 2004;99:2007–2011.

    Article  PubMed  Google Scholar 

  25. Rondagh EJA, Sanduleanu S, leClercq CMC, Winkens B, Masclee AA. Diverticulosis and colorectal polyps at a younger age: a possible link? Eur J Gastroenterol Hepatol. 2011;23:1050–1055.

    PubMed  Google Scholar 

  26. Lee SJ, Kim SA, Ku BH, et al. Association between colorectal cancer and colonic diverticulosis: case-control study based on computed tomographic colonography. Abdom Imaging. 2012;37:70–73.

    Article  PubMed  CAS  Google Scholar 

  27. Granlund J, Svensson T, Granath F, et al. Diverticular disease and the risk of colon cancer—a population-based case-control study. Aliment Pharmacol Ther. 2011;34:675–681.

    Article  PubMed  CAS  Google Scholar 

  28. Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJ, Felt-Bersma RJ. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis. 2008;23:979–984.

    Article  PubMed  CAS  Google Scholar 

  29. Krones CJ, Klinge U, Butz N, et al. The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia. Int J Colorectal Dis. 2006;21:18–24.

    Article  PubMed  CAS  Google Scholar 

  30. Morini S, Zullo A, Hassan C, Tomao S, Campo SM. Diverticulosis and colorectal cancer: between lights and shadows. J Clin Gastroenterol. 2008;42:763–770.

    Article  PubMed  Google Scholar 

  31. Ekbom A. Is diverticular disease associated with colonic malignancy? Dig Dis. 2012;30:46–50.

    Article  PubMed  Google Scholar 

  32. Schenck AP, Klabunde CN, Warren JL, et al. Data sources for measuring colorectal endoscopy use among Medicare enrollees. Cancer Epidemiol Biomarkers Prev. 2007;16:2118–2127.

    Article  PubMed  Google Scholar 

  33. Ko CW, Dominitz JA, Green P, Kreuter W, Baldwin LM. Accuracy of Medicare claims for identifying findings and procedures performed during colonoscopy. Gastrointest Endosc. 2011;73:447–453.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study used the linked SEER–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER–Medicare database. Supported by the National Cancer Institute at the National Institutes of Health, R01 CA132862, and the Case Comprehensive Cancer Center, P30 CA043703.

Confilct of interest

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Wearn 244, Cleveland, OH, 44106-5066, USA

    Gregory S. Cooper & Fang Xu

  2. Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA

    Fang Xu, Mark D. Schluchter, Siran M. Koroukian & Jill S. Barnholtz Sloan

  3. Case Comprehensive Cancer Center, 10900 Euclid Avenue, Cleveland, OH, 44106, USA

    Gregory S. Cooper, Mark D. Schluchter, Siran M. Koroukian & Jill S. Barnholtz Sloan

Authors
  1. Gregory S. Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fang Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark D. Schluchter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siran M. Koroukian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jill S. Barnholtz Sloan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory S. Cooper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cooper, G.S., Xu, F., Schluchter, M.D. et al. Diverticulosis and the Risk of Interval Colorectal Cancer. Dig Dis Sci 59, 2765–2772 (2014). https://doi.org/10.1007/s10620-014-3246-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3246-8

Keywords

Search

Navigation