Clinical studyIron deficiency and gastrointestinal malignancy: a population-based cohort study
Section snippets
Survey design and sample
The NHANES I was conducted between 1971 and 1974 on a nationwide probability sample of the civilian, noninstitutionalized population of the United States 9, 10. The survey included 14,407 participants aged 25 to 74 years who completed extensive questionnaires and had a physical examination and laboratory investigations. The NHEFS (11) attempted to locate these participants between 1982 and 1984 and to collect data on specific health conditions that had developed in the intervening period using
Results
Of the 9024 participants in this cohort, 716 (8%) were iron deficient, including 143 (1.6%) who were also anemic (Table 2 ). Eighteen participants (0.2%) were diagnosed with gastrointestinal malignancy during the 2-year period after the iron saturation and hemoglobin measurement. In 14 of these persons, the diagnosis was confirmed by hospital records; in the remaining 4 participants, it was based on information provided by the death certificate. There were 13 cancers of the colon or rectum,
Discussion
Previous studies 1, 2, 3, 4, 5, 8, 17, 18, 19 have emphasized the importance of iron deficiency anemia as a marker for occult gastrointestinal malignancy. However, it is likely that these studies overestimated the prevalence of these malignancies in persons with iron deficiency anemia (7), because almost all of these studies recruited patients who were referred to gastroenterology services for endoscopic evaluation. Indeed, in these prior studies, the mean hemoglobin level of patients
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Drs. Ioannou and Bryson are fellows at the Health Services Research and Development Program of the Veterans Affairs Puget Sound Health Care System, Seattle, Washington.