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

Research output: Contribution to journalArticle

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

Original languageEnglish
Pages (from-to)912-917
Number of pages6
JournalBritish Journal of Cancer
Volume122
Issue number6
Early online date13 Jan 2020
DOIs
Accepted/In press11 Dec 2019
E-pub ahead of print13 Jan 2020
Published17 Mar 2020

King's Authors

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.

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