Abstract
Abstract 5172
Iron deficiency anemia (IDA) is a common initial manifestation of gastrointestinal malignancies, but the relationship between chronic IDA and further cancer development is not established.
We would like to investigate the cancer risk of chronic IDA over a 10-year period in Taiwan.
We enrolled patients with iron deficiency anemia from a nationwide health registry in Taiwan during the period 2000–2009. All patients received at least 2 related examinations and were treated with iron supplement. Since IDA is an initial manifestation of many underlying malignancies, we excluded patients whose cancer developed within 1 year after IDA diagnosis. Standardized incidence ratios (SIRs) of cancers were calculated to compare the cancer incidence of chronic IDA patients to general population. The specific types of cancer were addressed.
A total of 4, 373 patient with IDA were identified, and 132 (3. 02%) IDA patients developed cancer 1 year after enrollment (SIR 1. 52; 95% confidence interval [CI] 1. 27 – 1. 80, p < 0. 001). The risks of kidney (SIR 5. 47, 95% CI 2. 73 – 9. 78), bladder (SIR 3. 6, 95% CI 1. 64 – 6. 83), liver (SIR 2. 80, 95% CI 1. 82 – 4. 13), and colorectal malignancies (SIR 1. 93, 95% CI 1. 22 – 2. 90) elevated. The risk of hematological malignancies were not increased in current study (SIR 1. 13, 95% CI 0. 31 – 2. 89, p = 0. 758).
After exclusion of cancer development within the first year, IDA patients still had increased risk of cancer, especially kidney, bladder, liver, and colorectal malignancies.
Characteristics of patients with iron deficiency anemia
| . | Total . | Male . | Female . |
|---|---|---|---|
| No. of patients | 4373 | 746 | 3627 |
| Person-years at risk | 21856.6 | 3320.82 | 18535.8 |
| Median follow-up, years (interquartile range) | 4.87 (2.66 – 7.18) | 4.10 (2.27 – 6.30) | 5.06 (2.77 – 7.31) |
| Median age, years (interquartile range) | 46.35 (38.37 – 58.40) | 65.95 (48.70 – 76.83) | 45.09 (37.23 – 51.32) |
| Age at diagnosis, years | |||
| 0 – 19 | 67 | 6 | 61 |
| 20 – 39 | 1170 | 97 | 1073 |
| 40 – 59 | 2090 | 206 | 1884 |
| 60 – 79 | 774 | 316 | 458 |
| ≥ 80 | 272 | 121 | 151 |
| . | Total . | Male . | Female . |
|---|---|---|---|
| No. of patients | 4373 | 746 | 3627 |
| Person-years at risk | 21856.6 | 3320.82 | 18535.8 |
| Median follow-up, years (interquartile range) | 4.87 (2.66 – 7.18) | 4.10 (2.27 – 6.30) | 5.06 (2.77 – 7.31) |
| Median age, years (interquartile range) | 46.35 (38.37 – 58.40) | 65.95 (48.70 – 76.83) | 45.09 (37.23 – 51.32) |
| Age at diagnosis, years | |||
| 0 – 19 | 67 | 6 | 61 |
| 20 – 39 | 1170 | 97 | 1073 |
| 40 – 59 | 2090 | 206 | 1884 |
| 60 – 79 | 774 | 316 | 458 |
| ≥ 80 | 272 | 121 | 151 |
Standardized incidence ratios (SIRs) according to age at diagnosis, gender and duration of iron deficiency anemia
| . | Total . | Male . | Female . | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Characteristics . | Observed . | Expected . | SIR (95% CI) . | Observed . | Expected . | SIR (95% CI) . | Observed . | Expected . | SIR (95% CI) . |
| All cancers | 132 | 86.75 | 1.52 (1.27 – 1.80) | 43 | 28.11 | 1.53 (1.11 – 2.06) | 89 | 58.64 | 1.52 (1.22 – 1.87) |
| Age at diagnosis, years | |||||||||
| 0 – 19 | 0 | 0.00 | 0.00 (0.00 – 900.53) | 0 | 0.00 | 0.00 (0.00 – 11307.26) | 0 | 0.00 | 0.00 (0.00 – 978.45) |
| 20 – 39 | 11 | 3.96 | 2.78 (1.39 – 4.97) | 0 | 0.23 | 0.00 (0.00 – 16.27) | 11 | 3.73 | 2.95 (1.47 – 5.27) |
| 40 – 59 | 51 | 36.72 | 1.39 (1.03 – 1.83) | 8 | 3.46 | 2.31 (1.00 – 4.56) | 43 | 33.26 | 1.29 (0.94 – 1.74) |
| 60 – 79 | 50 | 29.71 | 1.68 (1.25 – 2.22) | 25 | 14.99 | 1.67 (1.08 – 2.46) | 25 | 14.72 | 1.70 (1.10 – 2.51) |
| ≥ 80 | 20 | 16.35 | 1.22 (0.75 – 1.89) | 10 | 9.43 | 1.06 (0.51 – 1.95) | 10 | 6.91 | 1.45 (0.69 – 2.66) |
| Duration of iron deficiency anemia | |||||||||
| ≥ 1 | 132 | 86.75 | 1.52 (1.27 – 1.80) | 43 | 28.11 | 1.53 (1.11 – 2.06) | 89 | 58.64 | 1.52 (1.22 – 1.87) |
| 1 – 5 | 106 | 61.65 | 1.72 (1.41 – 2.08) | 38 | 21.20 | 1.79 (1.27 – 2.46) | 68 | 40.45 | 1.68 (1.31 – 2.13) |
| ≥ 5 | 26 | 25.10 | 1.04 (0.68 – 1.52) | 5 | 6.91 | 0.72 (0.23 – 1.69) | 21 | 18.18 | 1.15 (0.71 – 1.77) |
| . | Total . | Male . | Female . | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Characteristics . | Observed . | Expected . | SIR (95% CI) . | Observed . | Expected . | SIR (95% CI) . | Observed . | Expected . | SIR (95% CI) . |
| All cancers | 132 | 86.75 | 1.52 (1.27 – 1.80) | 43 | 28.11 | 1.53 (1.11 – 2.06) | 89 | 58.64 | 1.52 (1.22 – 1.87) |
| Age at diagnosis, years | |||||||||
| 0 – 19 | 0 | 0.00 | 0.00 (0.00 – 900.53) | 0 | 0.00 | 0.00 (0.00 – 11307.26) | 0 | 0.00 | 0.00 (0.00 – 978.45) |
| 20 – 39 | 11 | 3.96 | 2.78 (1.39 – 4.97) | 0 | 0.23 | 0.00 (0.00 – 16.27) | 11 | 3.73 | 2.95 (1.47 – 5.27) |
| 40 – 59 | 51 | 36.72 | 1.39 (1.03 – 1.83) | 8 | 3.46 | 2.31 (1.00 – 4.56) | 43 | 33.26 | 1.29 (0.94 – 1.74) |
| 60 – 79 | 50 | 29.71 | 1.68 (1.25 – 2.22) | 25 | 14.99 | 1.67 (1.08 – 2.46) | 25 | 14.72 | 1.70 (1.10 – 2.51) |
| ≥ 80 | 20 | 16.35 | 1.22 (0.75 – 1.89) | 10 | 9.43 | 1.06 (0.51 – 1.95) | 10 | 6.91 | 1.45 (0.69 – 2.66) |
| Duration of iron deficiency anemia | |||||||||
| ≥ 1 | 132 | 86.75 | 1.52 (1.27 – 1.80) | 43 | 28.11 | 1.53 (1.11 – 2.06) | 89 | 58.64 | 1.52 (1.22 – 1.87) |
| 1 – 5 | 106 | 61.65 | 1.72 (1.41 – 2.08) | 38 | 21.20 | 1.79 (1.27 – 2.46) | 68 | 40.45 | 1.68 (1.31 – 2.13) |
| ≥ 5 | 26 | 25.10 | 1.04 (0.68 – 1.52) | 5 | 6.91 | 0.72 (0.23 – 1.69) | 21 | 18.18 | 1.15 (0.71 – 1.77) |
SIR Standardized incidence ratio; CI confidence interval
Standardized incidence ratios (SIRs) for specific cancer types among patients with iron deficiency anemia
| . | Total . | ||
|---|---|---|---|
| Site of cancers . | Observed . | Expected . | SIR (95% CI) . |
| All cancers | 132 | 86.75 | 1.52 (1.27 – 1.80) |
| Head and neck | 9 | 4.32 | 2.08 (0.95 – 3.96) |
| Digestive | 57 | 27.93 | 2.04 (1.55 – 2.64) |
| Esophagus | 2 | 0.98 | 2.05 (0.25 – 7.41) |
| Stomach | 7 | 4.26 | 1.64 (0.66 – 3.39) |
| Colon and rectum | 23 | 11.91 | 1.93 (1.22 – 2.90) |
| Anus | 0 | 0.10 | 0.00 (0.00 – 38.50) |
| Liver and biliary tract | 25 | 9.29 | 2.69 (1.74 – 3.97) |
| Pancreas | 0 | 1.40 | 0.00 (0.00 – 2.63) |
| Lung and mediastinum | 5 | 9.90 | 0.50 (0.16 – 1.18) |
| Bone and Soft tissue | 0 | 0.66 | 0.00 (0.00 – 5.58) |
| Skin | 1 | 1.72 | 0.58 (0.01 – 3.24) |
| Breast | 13 | 16.44 | 0.79 (0.42 – 1.35) |
| Genitourinary | 37 | 16.39 | 2.26 (1.59 – 3.11) |
| Cervix | 3 | 4.05 | 0.74 (0.15 – 2.16) |
| Uterus | 6 | 2.35 | 2.55 (0.94 – 5.56) |
| Ovary | 5 | 2.04 | 2.45 (0.80 – 5.73) |
| Prostate | 3 | 3.44 | 0.87 (0.18 – 2.55) |
| Bladder | 9 | 2.50 | 3.60 (1.64 – 6.83) |
| Kidney | 11 | 2.01 | 5.47 (2.73 – 9.78) |
| Thyroid | 3 | 2.74 | 1.09 (0.23 – 3.20) |
| Hematologic malignancies | 4 | 3.55 | 1.13 (0.31 – 2.89) |
| All Others | 3 | 3.09 | 0.97 (0.20 – 2.84) |
| . | Total . | ||
|---|---|---|---|
| Site of cancers . | Observed . | Expected . | SIR (95% CI) . |
| All cancers | 132 | 86.75 | 1.52 (1.27 – 1.80) |
| Head and neck | 9 | 4.32 | 2.08 (0.95 – 3.96) |
| Digestive | 57 | 27.93 | 2.04 (1.55 – 2.64) |
| Esophagus | 2 | 0.98 | 2.05 (0.25 – 7.41) |
| Stomach | 7 | 4.26 | 1.64 (0.66 – 3.39) |
| Colon and rectum | 23 | 11.91 | 1.93 (1.22 – 2.90) |
| Anus | 0 | 0.10 | 0.00 (0.00 – 38.50) |
| Liver and biliary tract | 25 | 9.29 | 2.69 (1.74 – 3.97) |
| Pancreas | 0 | 1.40 | 0.00 (0.00 – 2.63) |
| Lung and mediastinum | 5 | 9.90 | 0.50 (0.16 – 1.18) |
| Bone and Soft tissue | 0 | 0.66 | 0.00 (0.00 – 5.58) |
| Skin | 1 | 1.72 | 0.58 (0.01 – 3.24) |
| Breast | 13 | 16.44 | 0.79 (0.42 – 1.35) |
| Genitourinary | 37 | 16.39 | 2.26 (1.59 – 3.11) |
| Cervix | 3 | 4.05 | 0.74 (0.15 – 2.16) |
| Uterus | 6 | 2.35 | 2.55 (0.94 – 5.56) |
| Ovary | 5 | 2.04 | 2.45 (0.80 – 5.73) |
| Prostate | 3 | 3.44 | 0.87 (0.18 – 2.55) |
| Bladder | 9 | 2.50 | 3.60 (1.64 – 6.83) |
| Kidney | 11 | 2.01 | 5.47 (2.73 – 9.78) |
| Thyroid | 3 | 2.74 | 1.09 (0.23 – 3.20) |
| Hematologic malignancies | 4 | 3.55 | 1.13 (0.31 – 2.89) |
| All Others | 3 | 3.09 | 0.97 (0.20 – 2.84) |
SIR Standardized incidence ratio; CI confidence interval
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
