Abstract
In a preliminary “years at risk” analysis of 5018 patients treated surgically for peptic ulcer at St. James Hospital, Balham, between 1940 and 1960, there was an increase in mortality from colorectal cancer 20 or more years after operation (1.6 fold;p<0.05) and an increase in mortality from breast cancer (4.0 fold;p<0.001). During the first 20 post-operative years there was an apparent decrease in mortality from both cancers (relative rate = 0.7 (NS) for colorectal and 0.5 (p<0.01), for breast cancer). The excess risk of colorectal cancer after a 20 year latency was almost entirely due to the 9.5 fold (p<0.001) excess risk in the 381 female gastric ulcer patients treated by Billroth I operation, and the 8.0 fold (p<0.05) excess mortality for the small group of 123 female patients who had vagotomy for duodenal ulcer. The apparent decreased risk during the first 20 post-operative years was entirely due to the 5-fold decrease (p<0.01) in risk in the 659 male patients treated by Billroth I surgery for gastric ulcer. The ratio of colon: rectal cancers was very much higher in gastric ulcer than in duodenal ulcer patients (5.6 compared to 1.8) and higher in females than in males (6.0 compared to 2.4). The excess risk of breast cancer after a 20 year latency was 4-fold in both gastric ulcer and duodenal ulcer patients. In duodenal ulcer patients the risk was greatest in those treated by vagotomy whilst in the gastric ulcer patients no treatment sub-groups had a statistically significant increase. During the first 20 post-operative years the apparent decrease in risk was entirely in the gastric ulcer patients. We conclude that the increased risk of colorectal cancer 20 years after gastric surgery is limited to females, and is mirrored by a decrease in males during the first 20 years. These sex differences were virtually limited to gastric ulcer patients. For breast cancer the increased risk after 20 years affects gastric ulcer and duodenal ulcer patients equally.
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Caygill, C.P.J., Hill, M.J., Kirkham, J.S. et al. Mortality from colorectal and breast cancer in gastric-surgery patients. Int J Colorect Dis 3, 144–148 (1988). https://doi.org/10.1007/BF01648356
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DOI: https://doi.org/10.1007/BF01648356