In a study among U.S. veterans reported in the Journal of Clinical Oncology, Shah et al found that Helicobacter pylori infection was associated with an increased risk of colorectal cancer and cancer-related death; additionally, treated H pylori infection was associated with reduced cancer incidence and cancer-related death vs untreated infection.
Study Details
The study included U.S. veterans within the Veterans Health Administration who completed H pylori testing between 1999 and 2018. The primary outcome measures were colorectal cancer incidence and mortality. Follow-up started at first H pylori testing and continued until the earliest of incident or fatal colorectal cancer, non–colorectal cancer death, or December 2019.
Key Findings
Among 812,736 individuals tested for H pylori, 205,178 (25.2%) tested positive. Over a follow-up of up to 15 years, H pylori–positive vs –negative status was associated with an increased risk of colorectal cancer (adjusted hazard ratio [HR] = 1.18, 95% confidence interval [CI] = 1.12–1.24) and colorectal cancer–related death (adjusted HR = 1.12, 95% CI = 1.03–1.21) on multivariate analysis.
Among H pylori–positive individuals, 135,123 received treatment and 70,055 did not receive treatment for their infection. No treatment vs treatment was associated with a significantly increased risk of colorectal cancer (adjusted HR = 1.23, 95% CI = 1.13–1.34) and colorectal cancer–related mortality (adjusted HR = 1.40, 95% CI = 1.24–1.58) on multivariate analysis.
The investigators concluded, “H pylori positivity may be associated with small but statistically significant higher colorectal cancer incidence and mortality; untreated individuals, especially those with confirmed active infection, appear to be most at risk.”
Shailja C. Shah, MD, MPH, of the Division of Gastroenterology, University of California, San Diego, and VA San Diego Healthcare System, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a Veterans Affairs Career Development Award, the National Institutes of Health, and the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
