Published: 28-10-2022 11:28 | Updated: 02-02-2023 10:20

Diverticular disease associated with cancer outside gastrointestinal tract

Through the ESPRESSO cohort, researchers from Massachusetts General Hospital, Boston, University of Newcastle, Australia, University of Washington, Seattle, and Karolinska Institutet examined the risk of cancer among 75,000 patients with a diagnosis of diverticular disease and colorectal histopathology. The paper is now published in JNCI, the Journal of the National Cancer Institute.

Photo of Wenjie Ma, researcher at Mass General Research Institute
Wenjie Ma, researcher at Mass General Research Institute Photo: N/A

The ESPRESSO cohort covers all histopathology reports from Sweden’s 28 pathology departments. Through linkage with the Swedish national patient register, researchers identified patients with diverticular disease. Diverticular disease can present through gastrointestinal bleeding, but also through diverticulitis when patients may have fever, nausea and abdominal pain. Previous research has focused on colorectal cancer development in diverticular disease but less has been know about cancer development elsewhere. The researchers found a 33% increased risk of overall cancer in Swedish patients with diverticular disease.

“This is the first nationwide cohort study to demonstrate that diverticular disease is associated with an increased, long-term risk of overall cancer", says first-author Wenjie Ma from Massachusetts General Hospital. "Diverticular disease is associated with an increased risk of specific cancers, including liver cancer and lung cancer.”

She also adds that “Given the high prevalence of diverticular disease, our results highlight the need for awareness for cancer, not only for colorectal cancer, in patients with diverticular disease.”

Patients with diverticular disease had significantly increased overall cancer incidence (24.5 vs. 18.1 cancer cases per 1,000 person-years). After adjusting for covariates, these rates corresponded to 1 extra cancer case in 16 individuals with diverticular disease followed for ten years.

Portrait photo of Professor Jonas Ludvigsson in front of Aula Medica at Karolinska Institutet
Jonas Ludvigsson, Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Senior physician at the Department of Paediatrics, Örebro University Hospital. Photo: Alexander Donka. Photo: Alexander Donka

“There has been a lot of research on extraintestinal cancer in other bowel disorders such as inflammatory bowel disease (IBD) and celiac disease, but less is known about diverticular disease”, says senior author Jonas F Ludvigsson, pediatrician at Örebro University Hospital and professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.

“These data suggest that patients with diverticular disease are at increased risk of other cancers than colorectal cancer, but it should also be emphasized that the absolute risk for cancer was moderate”, adds Ludvigsson. “I hope other researchers are inspired by our findings and explore the biological mechanisms underlying the association between diverticular disease and cancer”, he concludes.

Dr Ludvigsson has coordinated a study on behalf of the Swedish IBD quality register (SWIBREG). That study received funding from the Janssen corporation.

The study was supported by the Swedish Cancer Foundation (JFL). WM reported support from MGH Executive Committee on Research Tosteson and Fund for Medical Discovery Postdoctoral Fellowship Award and American Gastroenterological Association Research Scholar Award (AGA2021-13-01). ATC and LLS reported support from the National Institutes of Health (R01 DK101495). Dr. Chan was supported by a Stuart and Suzanne Steele MGH Research Scholar Award.


Cancer risk in patients with diverticular disease: a nationwide cohort study.
Ma W, Walker MM, Thuresson M, Roelstraete B, Sköldberg F, Olén O, Strate LL, Chan AT, Ludvigsson JF
J Natl Cancer Inst 2022.