Iron status and colorectal cancer in symptomatic elderly patients.

Objective: The study aim is to determine the relationship between the prevalence of colorectal cancer and iron status in elderly anemic and non-anemic patients.

Methods: We retrospectively investigated 359 consecutive elderly patients, aged 70 years and more, who presented to a geriatric department and who underwent a total colonoscopy. The histopathologic diagnosis of colorectal carcinoma was the primary outcome measure, and its presence was compared with the iron status, evaluated by serum ferritin and hemoglobin levels.

Results: Less than half of the patients with colorectal carcinoma had iron-deficiency anemia. The prevalence of colorectal carcinoma was similar among patients with a serum ferritin level less than 50 microg/L (16%), between 50 and 100 mirog/L (20%), and greater than 100 microg/L (13%), and was not different between anemic and non-anemic patients. Sex (odds ratio for men 2.1; 95% confidence interval [CI], 1.2-3.9) and increasing age (6.6% per year; 95% CI, 1.2-12.4), but not hemoglobin and serum ferritin, were independent risk factors for colorectal carcinoma. Those with a proximal colorectal carcinoma had a lower hemoglobin and ferritin level and a higher prevalence of iron-deficiency anemia compared with patients with a distal colorectal carcinoma.

Conclusion: The prevalence of colorectal carcinoma is high in anemic and non-anemic elderly symptomatic patients, irrespective of the iron status. Therefore, the decision to order a colonoscopy in older patients should not only be considered in patients with anemia or iron deficiency but also in patients with suspicious symptoms without anemia or iron deficiency.