Iron deficiency and symptoms in women aged 20–49 years and relation to upper gastrointestinal and colon cancers

Abstract

ObjectiveIron deficiency anaemia (IDA) in women aged 20–49 years may be caused by menses or gastrointestinal cancer. Data are sparse on the yield of endoscopy/colonoscopy in this population. Our aim was to determine the association of IDA and symptoms with cancers.DesignRetrospective cohort study within Kaiser Permanente Northern California. Participants were women aged 20–49 years tested for iron stores and anaemia during 1998, 2004 and 2010 and followed for 5 years for outcomes of oesophageal, gastric and colon cancers. Symptoms from the three prior years were grouped into dysphagia, upper gastrointestinal (UGI), lower gastrointestinal (LGI), rectal bleeding and weight loss.ResultsAmong 9783 anaemic women aged 20–49 years, there were no oesophageal, 6 gastric and 26 colon cancers. Incidences per 1000 for gastric cancer with and without iron deficiency (ID) were 0.60 (95% CI 0.23 to 1.55) and 0.63 (95% CI 0.17 to 2.31), and for colon cancer, 2.72 (95% CI 1.72 to 4.29) and 2.53 (95% CI 1.29 to 4.99). Endoscopies for UGI or dysphagia symptoms rather than bidirectional endoscopy for ID yielded more gastric cancers (n=5 and n=4, respectively) with fewer procedures (3793 instead of 6627). Colonoscopies for LGI or rectal bleed instead of for ID would detect more colon cancers (n=19 and n=18) with about 40% of the procedures (=2793/6627).ConclusionsUGI and colon cancers were rare in women of menstruating age and when controlled for anaemia were as common without as with ID. Using symptoms rather than IDA as an indication for endoscopy found equal numbers of cancers with fewer procedures.

Prevalence of gastrointestinal malignancy in non‐anemic iron deficiency and significance for endoscopic screening: A Western Australian multicenter cohort study

“…In their study, men and postmenopausal women had a 31 times greater risk of malignancy in the presence of IDA and 5 times greater risk with NAID. This is reflected in multiple other studies that have identified that GI malignancies in women of menstruating age are rare, with no change in risk in the presence of iron deficiency 7,15 . We were unable to complete a subgroup analysis for premenopausal and postmenopausal women with IDA or NAID due to missing data.…”

“…This is reflected in multiple other studies that have identified that GI malignancies in women of menstruating age are rare, with no change in risk in the presence of iron deficiency. 7,15 We were unable to complete a subgroup analysis for premenopausal and postmenopausal women with IDA or NAID due to missing data. But in our iron-deficient cohort, male gender conferred a three times greater risk of malignancy overall.…”

Association between iron deficiency anemia and subsequent stomach and colorectal cancer diagnosis in Germany

“…The authors noted that upper GI cancer and CRC overall are rare in women of childbearing age and are not affected by the presence or absence of IDA. However, when symptoms rather than IDA were used as an indication for endoscopy, they found the same number of cancers with fewer procedures (Szpakowski and Tucker 2022 ).…”

Peripapillary nerve fiber layer in patients with iron deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India

“…found out IDA anemia is common in women aged 20–49 years due to excessive menses and gastrointestinal cancers. [ 12 ] A high prevalence has been documented in preschool children and women in the reproductive age group in Africa and Southeast Asia. [ 13 ] The etiology of IDA is multifactorial, and the causes include nutritional deficiencies, chronic and acute infections, blood dyscrasias, obesity, and parasitic infestations.…”