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Serum Ferritin Concentration and Recurrence of Colorectal Adenoma

Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709 [M. T.]; Departments of Medicine and Community and Family Medicine and Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire 03755 [E. R. G., J. A. B.]; Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina 27599 [R. S. S.]; Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles, California 90033 [R. W. H.]; Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111 [B. S. B.]; and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892 [K. A. M.]

Both body iron stores and dietary iron intake have been reported to increase risk of colorectal neoplasms. We assessed whether serum ferritin concentration was associated with recurrence of colorectal adenomas among 733 individuals with baseline determinations of ferritin as part of a multicenter clinical trial of antioxidant supplements for adenoma prevention. All study participants had at least one adenoma removed within 3 months before enrollment, and 269 of them developed one or more adenomas between follow-up colonoscopies conducted 1 and 4 years after enrollment. Baseline serum ferritin concentrations were analyzed both as a log-transformed continuous variable and as a categorical variable, defined as whether iron stores were nonreplete and low (ferritin 30 µg/liter), nonreplete and borderline (31–70 µg/liter), replete and adequate (71–160 µg/liter), or replete and high (>160 µg/liter). Analyses were based on multiple logistic regression models, including age, sex, study center, energy, alcohol, fiber, folate, and total fat intake, number of months between colonoscopic examinations, smoking status, and aspirin use. Overall, there was no statistically significant linear association between log ferritin concentration and adenoma recurrence (P = 0.33). Risk of adenoma recurrence was modestly increased among participants with ferritin concentrations >70 µg/liter relative to those with lower ferritin (odds ratio, 1.39; 95% confidence interval, 0.96–2.02). This result seemed more pronounced among women than men. Dietary intake of iron and red meat was inversely associated with adenoma recurrence among participants with replete iron stores but not consistently associated among those with nonreplete stores. Our findings suggest that any role of iron stores and dietary iron in influencing risk of colorectal adenoma recurrence is likely complex.

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