The association between colorectal cancer and prior antibiotic prescriptions: case control study

David Armstrong; Alex Dregan; Mark Ashworth; Patrick White; Chris McGee; Simon de Lusignan

doi:10.1038/s41416-019-0701-5

The association between colorectal cancer and prior antibiotic prescriptions: case control study

David Armstrong^*, Alex Dregan, Mark Ashworth, Patrick White, Chris McGee, Simon de Lusignan

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. Methods: A case control study used the RCGP’s Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer. Results: A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61–2.19, p < 0.001). Conclusions: Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.

Original language	English
Pages (from-to)	912-917
Number of pages	6
Journal	British Journal of Cancer
Volume	122
Issue number	6
Early online date	13 Jan 2020
DOIs	https://doi.org/10.1038/s41416-019-0701-5
Publication status	Published - 17 Mar 2020

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The association of colorectal_ARMSTRONG_Accepted11December2019_Published13January2020 VoR (CC BY)Final published version, 420 KBLicence: CC BY

Cite this

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title = "The association between colorectal cancer and prior antibiotic prescriptions: case control study",

abstract = "Background: Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. Methods: A case control study used the RCGP{\textquoteright}s Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer. Results: A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61–2.19, p < 0.001). Conclusions: Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.",

author = "David Armstrong and Alex Dregan and Mark Ashworth and Patrick White and Chris McGee and {de Lusignan}, Simon",

year = "2020",

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doi = "10.1038/s41416-019-0701-5",

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journal = "British Journal of Cancer",

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T1 - The association between colorectal cancer and prior antibiotic prescriptions

T2 - case control study

AU - Armstrong, David

AU - Dregan, Alex

AU - Ashworth, Mark

AU - White, Patrick

AU - McGee, Chris

AU - de Lusignan, Simon

PY - 2020/3/17

Y1 - 2020/3/17

N2 - Background: Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. Methods: A case control study used the RCGP’s Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer. Results: A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61–2.19, p < 0.001). Conclusions: Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.

AB - Background: Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. Methods: A case control study used the RCGP’s Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer. Results: A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61–2.19, p < 0.001). Conclusions: Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.

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DO - 10.1038/s41416-019-0701-5

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SN - 0007-0920

VL - 122

SP - 912

EP - 917

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 6

ER -

The association between colorectal cancer and prior antibiotic prescriptions: case control study

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