title: Gynecological malignancy risk in colorectal cancer survivors: A population-based cohort study.
abstract: OBJECTIVE
  This study was carried out to assess the risk of gynecological malignancy in colorectal cancer survivors using a population-based retrospective cohort study.
  
  
  METHODS
  Using the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 37,176 patients with colorectal cancer diagnosed in 1998-2009, aged 20 years and above, without other cancer history. We also randomly selected 148,700 women without any cancer in the comparison cohort, frequency matched by age and diagnosis date. Incidences and hazards of breast, cervix, endometrial and ovarian cancers were evaluated by 201l.
  
  
  RESULTS
  The overall incidence of the 4 types of gynecological cancer was 39.0% higher in colorectal cancer patients than in comparisons (2.99 vs. 2.14 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.46 (95% confidence interval (CI) = 1.31-1.62). Breast cancer accounted for most subsequent cancer. The multivariable Cox method measured HR was the highest for endometrial cancer (3.40, 95% CI = 2.59-4.47) for the colorectal cohort relative to comparisons, followed by ovarian cancer and breast cancer, except cervix cancer. The risk of gynecological malignancies was apparently elevated for colorectal cancer survivors <50 years of age.
  
  
  CONCLUSIONS
  Follow-up measures are suggested for women with colorectal cancer for early detection and prevention of the subsequent gynecological malignancy.
authors: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Gynecology and Obstetrics, China Medical University Hospital, Taichung, Taiwan.
authors: Wei-Chun
authors: WC
authors: Chang
authors: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors: Chih-Hsin
authors: CH
authors: Muo
authors: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
authors: Ji-An
authors: JA
authors: Liang
authors: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors: Fung-Chang
authors: FC
authors: Sung
authors: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors: Chia-Hung
authors: CH
authors: Kao
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D016208:Databases, Factual; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D017741:Survivors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Breast cancer; Colorectal cancer; Endometrial cancer; Insurance data; Ovarian cancer; Retrospective cohort study