Increased Colorectal Cancer Rate in Turner Syndrome: A Case Control Study

Female sex hormonal supplementation had been shown to be protective against Colorectal cancer (CRC). Turner syndrome (TS) is a rare X lined chromosomal disorder associated with sex hormonal deficiency. Hence, we hypothesized that that females with TS would be at an increased risk of CRC. From the Truven Health Marketscan Commercial Claims and Encounters Database, female patients who had colonoscopy with TS were compared to aged matched to controls. For these patients we obtained demographic variables, risk factors (diabetes, morbid obesity, smoking, use of non-steroidal anti-inflammatory drugs and statins) and endoscopic results (adenoma and cancer detection) from the database. Multivariate logistic regression analysis was performed to compare the cancer detection rates in both groups. Of the 7,77,36,681 patients of age 35 or older in the database 3265 had TS. Of those 546 (17%) patients had a colonoscopy that was reported. These patients were compared to 1059 age matched controls. Prevalence of diabetes (14.3 vs 8.4, P<0.001), and smoking (2.6 vs 0.9, p=0.01) was higher in patients with TS. Cancer detection rate was higher in patients with TS (1.1% vs 0.2%, p=0.01). After adjustment for the above variables, patients with TS have an adjusted odds ratio of 9.5 for CRC at any colonoscopy (95% CI 1.7-52.8, p =0.008). Hence, we concluded that in the studied cohort of TS patients there was a higher colorectal cancer detection rate at any colonoscopy when compared to their age matched female counterparts. TS patients represent a ‘disparity group’ who warrant enhanced CRC screening.