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Abstract：
BACKGROUND: Colorectal cancer (CRC) is estimated to be the fourth most common cancer diagnosis in Canada (except for nonmelanoma skin cancers) and the second and third leading cause of cancer-related death in male and female individuals, respectively.
OBJECTIVE: The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients\' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis.
METHODS: We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as \"cases\"), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older).
RESULTS: We included 1001 EAO-CRC cases (n=450, 45% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95% CI 13.1-18.6).
CONCLUSIONS: We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC.
OBJECTIVE: The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients\' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis.
METHODS: We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as \"cases\"), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older).
RESULTS: We included 1001 EAO-CRC cases (n=450, 45% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95% CI 13.1-18.6).
CONCLUSIONS: We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC.
摘要：
背景：据估计，结直肠癌（CRC）是加拿大第四大最常见的癌症诊断（非黑色素瘤皮肤癌除外），是男性和女性个体中癌症相关死亡的第二和第三大原因。分别。
目的：早发性结直肠癌（EAO-CRC；诊断时间小于50年）发病率的上升要求更好地了解患者的诊断途径。因此,我们评估了EAO-CRC诊断前的处方药使用模式.
方法：我们使用不列颠哥伦比亚省（BC）的链接行政卫生数据库，加拿大,确定2010年1月1日至2016年12月31日期间诊断为EAO-CRC的个体（以下简称“病例”），与无癌对照(1:10)一起，年龄和性别相匹配。我们确定了诊断前一年从社区药房分配的所有处方，并使用解剖治疗化学分类系统3级根据药物类别对处方进行分组。对诊断为平均年龄起病CRC（诊断为50岁及以上）的个体进行平行评估。
结果：我们纳入了1001例EAO-CRC病例（n=450，45％为女性参与者；平均41.0，SD6.1年），797人(79.7%)在诊断前一年填写了12,989张处方。最主要的药物是抗抑郁药（第一；n=1698，13.1%）。治疗消化性溃疡和胃食管反流病的药物(第三;n=795,6.1%)更有可能被EAO-CRC病例填充(比值比[OR]1.4,95%CI1.2-1.7),并且填充频率更高(OR1.8,95%CI1.7-1.9)。我们注意到痔疮和肛裂外用药物的类似模式，与对照组相比，EAO-CRC病例更有可能填充（OR7.4，95％CI5.8-9.4），并且填充频率更高（OR15.6，95％CI13.1-18.6）。
结论：我们观察到EAO-CRC诊断前一年频繁使用处方药，包括治疗EAO-CRC常见症状的药物。
目的：早发性结直肠癌（EAO-CRC；诊断时间小于50年）发病率的上升要求更好地了解患者的诊断途径。因此,我们评估了EAO-CRC诊断前的处方药使用模式.
方法：我们使用不列颠哥伦比亚省（BC）的链接行政卫生数据库，加拿大,确定2010年1月1日至2016年12月31日期间诊断为EAO-CRC的个体（以下简称“病例”），与无癌对照(1:10)一起，年龄和性别相匹配。我们确定了诊断前一年从社区药房分配的所有处方，并使用解剖治疗化学分类系统3级根据药物类别对处方进行分组。对诊断为平均年龄起病CRC（诊断为50岁及以上）的个体进行平行评估。
结果：我们纳入了1001例EAO-CRC病例（n=450，45％为女性参与者；平均41.0，SD6.1年），797人(79.7%)在诊断前一年填写了12,989张处方。最主要的药物是抗抑郁药（第一；n=1698，13.1%）。治疗消化性溃疡和胃食管反流病的药物(第三;n=795,6.1%)更有可能被EAO-CRC病例填充(比值比[OR]1.4,95%CI1.2-1.7),并且填充频率更高(OR1.8,95%CI1.7-1.9)。我们注意到痔疮和肛裂外用药物的类似模式，与对照组相比，EAO-CRC病例更有可能填充（OR7.4，95％CI5.8-9.4），并且填充频率更高（OR15.6，95％CI13.1-18.6）。
结论：我们观察到EAO-CRC诊断前一年频繁使用处方药，包括治疗EAO-CRC常见症状的药物。
