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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Community-Acquired Escherichia coli Bacteremia after Age 50 and Subsequent Incidence of a Cancer Diagnosis: A Danish Population–Based Cohort Study

Kirstine K. Søgaard, Katalin Veres, Christina M.J.E. Vandenbroucke-Grauls, Jan P. Vandenbroucke, Henrik T. Sørensen and Henrik C. Schønheyder
Kirstine K. Søgaard
1Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.
2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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  • For correspondence: kks@clin.au.dk
Katalin Veres
2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Christina M.J.E. Vandenbroucke-Grauls
3Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
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Jan P. Vandenbroucke
2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
4Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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Henrik T. Sørensen
2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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  • ORCID record for Henrik T. Sørensen
Henrik C. Schønheyder
1Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.
5Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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DOI: 10.1158/1055-9965.EPI-20-0705 Published December 2020
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Abstract

Background: Community-acquired bacteremia (CAB) with Escherichia coli may signal occult cancer. This might differ between phylogenetic groups.

Methods: We conducted a population-based cohort study in northern Denmark (1994–2013) to examine whether E. coli CAB after age 50 is associated with incident cancer. We followed patients from their bacteremia diagnosis date to identify subsequent gastrointestinal, hepatobiliary, and urinary tract cancer diagnoses. We calculated 1- and 5-year cumulative cancer incidence. We compared the observed incidence with that expected based on national cancer incidence rates, and computed standardized incidence ratios (SIR) at 0–<1 year and ≥1 year. In a subcohort, we assessed the prevalence of phylogenetic groups.

Results: Among 2,735 patients with E. coli CAB, 173 later were diagnosed with cancer. The 1-year cumulative incidence of a gastrointestinal or hepatobiliary tract cancer was 1.9%, and the 0–<1-year SIR was 5.44 [95% confidence interval (CI), 4.06–7.14]. For urinary tract cancer, the corresponding estimates were 1.0% and 3.41 (95% CI, 2.27–4.93). All individual cancers occurred more often than expected during the first year following E. coli CAB, but thereafter the relative risks declined toward unity. Still, the ≥1-year SIR for colorectal cancer remained 1.4-fold elevated, and the SIR for liver, pancreas, gallbladder, and biliary tract cancer was 2-fold elevated. The prevalence of phylogenetic groups was similar among patients with and without cancer.

Conclusions: Gastrointestinal, hepatobiliary, and urinary tract cancer may debut with E. coli CAB.

Impact: Owing to the high incidence of E. coli bacteremia, cancers missed at the time of bacteremia diagnosis represent a clinically significant problem.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;29:2626–32

  • Received May 16, 2020.
  • Revision received July 3, 2020.
  • Accepted September 25, 2020.
  • Published first September 30, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (12)
December 2020
Volume 29, Issue 12
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Community-Acquired Escherichia coli Bacteremia after Age 50 and Subsequent Incidence of a Cancer Diagnosis: A Danish Population–Based Cohort Study
Kirstine K. Søgaard, Katalin Veres, Christina M.J.E. Vandenbroucke-Grauls, Jan P. Vandenbroucke, Henrik T. Sørensen and Henrik C. Schønheyder
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2626-2632; DOI: 10.1158/1055-9965.EPI-20-0705

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Community-Acquired Escherichia coli Bacteremia after Age 50 and Subsequent Incidence of a Cancer Diagnosis: A Danish Population–Based Cohort Study
Kirstine K. Søgaard, Katalin Veres, Christina M.J.E. Vandenbroucke-Grauls, Jan P. Vandenbroucke, Henrik T. Sørensen and Henrik C. Schønheyder
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2626-2632; DOI: 10.1158/1055-9965.EPI-20-0705
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