Skip to main content
Gut logoLink to Gut
. 1996 Sep;39(3):439–443. doi: 10.1136/gut.39.3.439

Risk of colorectal cancer and other cancers in patients with gall stones.

C Johansen 1, W H Chow 1, T Jørgensen 1, L Mellemkjaer 1, G Engholm 1, J H Olsen 1
PMCID: PMC1383353  PMID: 8949651

Abstract

BACKGROUND: The occurrence of gall stones has repeatedly been associated with an increased risk for cancer of the colon, but risk associated with cholecystectomy remains unclear. AIMS: To evaluate the hypothesis in a nationwide cohort of more than 40,000 gall stone patients with complete follow up including information of cholecystectomy and obesity. PATIENTS: In the population based study described here, 42,098 patients with gall stones in 1977-1989 were identified in the Danish Hospital Discharge Register. METHODS: These patients were linked to the Danish Cancer Registry to assess their risks for colorectal and other cancers during follow up to the end of 1992. RESULTS: The analysis showed a modest increase in the number of cancers at all sites combined (n = 3940; RR, 1.07; 95% confidence intervals (CI), 1.0 to 1.1). A weak association was found for cancer of the colon (n = 360; RR, 1.09; 95% CI 1.0 to 1.2), which remained unchanged when analysed by sex, anatomical subsite, and duration of follow up. Multivariate analysis with adjustment for cholecystectomy and clinically defined obesity did not change these estimates to any significant extent. Excess risks were found for cancers of the pancreas and the small intestine. A non-significant increased risk for breast cancer was seen in women five years after initial discharge for gall stones. CONCLUSION: A borderline significant association was seen between gall stones and cancer of the colon, and for cancer of pancreas and small intestine as well as for breast cancer in women.

Full text

PDF
442

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adami H. O., Meirik O., Gustavsson S., Nyrén O., Krusemo U. B. Cholecystectomy and the incidence of breast cancer: a cohort study. Br J Cancer. 1984 Feb;49(2):235–239. doi: 10.1038/bjc.1984.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Allende H. D., Ona F. V., Davis H. T. Gallbladder disease: risk factor for colorectal carcinoma? J Clin Gastroenterol. 1984 Feb;6(1):51–55. [PubMed] [Google Scholar]
  3. Almond H. R., Vlahcevic Z. R., Bell C. C., Jr, Gregory D. H., Swell L. Bile acid pools, kinetics and biliary lipid composition before and after cholecystectomy. N Engl J Med. 1973 Dec 6;289(23):1213–1216. doi: 10.1056/NEJM197312062892302. [DOI] [PubMed] [Google Scholar]
  4. Bandettini L., Filipponi F., Romagnoli P. Increase of the mitotic index of colonic mucosa after cholecystectomy. Cancer. 1986 Aug 1;58(3):685–687. doi: 10.1002/1097-0142(19860801)58:3<685::aid-cncr2820580314>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  5. Breuer N. F., Katschinski B., Mörtl E., Leder L. D., Goebell H. Large bowel cancer risk in cholelithiasis and after cholecystectomy. Postmortem study. Digestion. 1988;40(4):219–226. doi: 10.1159/000199658. [DOI] [PubMed] [Google Scholar]
  6. Doouss T. W., Castleden W. M. Gallstones and carcinoma of the large bowel. N Z Med J. 1973 Mar;77(490):162–165. [PubMed] [Google Scholar]
  7. Ekbom A., Yuen J., Adami H. O., McLaughlin J. K., Chow W. H., Persson I., Fraumeni J. F., Jr Cholecystectomy and colorectal cancer. Gastroenterology. 1993 Jul;105(1):142–147. doi: 10.1016/0016-5085(93)90019-9. [DOI] [PubMed] [Google Scholar]
  8. Eriksson S. G., Lindström C. G. Lack of relationship between cholecystectomy and colorectal cancer. A case control autopsy study in a defined population. Scand J Gastroenterol. 1984 Oct;19(7):977–982. [PubMed] [Google Scholar]
  9. Gafà M., Sarli L., Sansebastiano G., Longinotti E., Carreras F., Pietra N., Peracchia A. Prevention of colorectal cancer. Role of association between gallstones and colorectal cancer. Dis Colon Rectum. 1987 Sep;30(9):692–696. doi: 10.1007/BF02561690. [DOI] [PubMed] [Google Scholar]
  10. Giovannucci E., Colditz G. A., Stampfer M. J. A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology. 1993 Jul;105(1):130–141. doi: 10.1016/0016-5085(93)90018-8. [DOI] [PubMed] [Google Scholar]
  11. Gudmundsson S., Möller T. R., Olsson H. Cancer incidence after cholecystectomy--a cohort study with 30 years follow-up. Eur J Surg Oncol. 1989 Apr;15(2):113–117. [PubMed] [Google Scholar]
  12. Hepner G. W., Hofmann A. F., Malagelada J. R., Szczepanik P. A., Klein P. D. Increased bacterial degradation of bile acids in cholecystectomized patients. Gastroenterology. 1974 Apr;66(4):556–564. [PubMed] [Google Scholar]
  13. Hill M. J., Drasar B. S., Williams R. E., Meade T. W., Cox A. G., Simpson J. E., Morson B. C. Faecal bile-acids and clostridia in patients with cancer of the large bowel. Lancet. 1975 Mar 8;1(7906):535–539. doi: 10.1016/s0140-6736(75)91556-1. [DOI] [PubMed] [Google Scholar]
  14. Jørgensen T., Rafaelsen S. Gallstones and colorectal cancer--there is a relationship, but it is hardly due to cholecystectomy. Dis Colon Rectum. 1992 Jan;35(1):24–28. doi: 10.1007/BF02053334. [DOI] [PubMed] [Google Scholar]
  15. Layde P. M., Vessey M. P., Yeates D. Risk factors for gall-bladder disease: a cohort study of young women attending family planning clinics. J Epidemiol Community Health. 1982 Dec;36(4):274–278. doi: 10.1136/jech.36.4.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Linos D., Beard C. M., O'Fallon W. M., Dockerty M. B., Beart R. W., Jr, Kurland L. T. Cholecystectomy and carcinoma of the colon. Lancet. 1981 Aug 22;2(8243):379–381. doi: 10.1016/s0140-6736(81)90829-1. [DOI] [PubMed] [Google Scholar]
  17. Lowenfels A. B., Domellöf L., Lindström C. G., Bergman F., Monk M. A., Sternby N. H. Cholelithiasis, cholecystectomy, and cancer: a case-control study in Sweden. Gastroenterology. 1982 Sep;83(3):672–676. [PubMed] [Google Scholar]
  18. Machnik G., Füller C., Füller J., Kunath H. Explorative Untersuchungen zum gemeinsamen Vorkommen von Cholelithiasis, Zustand nach Cholezystektomie und Kolonkarzinom. Dtsch Z Verdau Stoffwechselkr. 1986;46(1):22–29. [PubMed] [Google Scholar]
  19. Maringhini A., Moreau J. A., Melton L. J., 3rd, Hench V. S., Zinsmeister A. R., DiMagno E. P. Gallstones, gallbladder cancer, and other gastrointestinal malignancies. An epidemiologic study in Rochester, Minnesota. Ann Intern Med. 1987 Jul;107(1):30–35. doi: 10.7326/0003-4819-107-1-30. [DOI] [PubMed] [Google Scholar]
  20. Reddy B. S., Wynder E. L. Metabolic epidemiology of colon cancer. Fecal bile acids and neutral sterols in colon cancer patients and patients with adenomatous polyps. Cancer. 1977 Jun;39(6):2533–2539. doi: 10.1002/1097-0142(197706)39:6<2533::aid-cncr2820390634>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  21. Roda E., Aldini R., Mazzella G., Roda A., Sama C., Festi D., Barbara L. Enterohepatic circulation of bile acids after cholecystectomy. Gut. 1978 Jul;19(7):640–649. doi: 10.1136/gut.19.7.640. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schmauss A. K., Ehrhardt U. Cholelithiasis--Cholezystektomie und Kolonkarzinom. Zentralbl Chir. 1983;108(8):449–456. [PubMed] [Google Scholar]
  23. Turunen M. J., Kivilaakso E. O. Increased risk of colorectal cancer after cholecystectomy. Ann Surg. 1981 Nov;194(5):639–641. doi: 10.1097/00000658-198111000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wysowski D. K., Goldberg E. L., Comstock G. W., Diamond E. L. A study of a possible association between breast cancer and gallbladder disease. Am J Epidemiol. 1986 Mar;123(3):532–543. doi: 10.1093/oxfordjournals.aje.a114268. [DOI] [PubMed] [Google Scholar]
  25. de Waard F., Baanders-van Halewijn E. A. A prospective study in general practice on breast-cancer risk in postmenopausal women. Int J Cancer. 1974 Aug 15;14(2):153–160. doi: 10.1002/ijc.2910140203. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES