Serum bilirubin levels and risk of colorectal cancer in Korean adults: results from the Korean Genome and Epidemiology Study-Health Examinee (KoGES-HEXA) Cohort Study

A new study by scientists from the International Agency for Research on Cancer (IARC), in collaboration with researchers from the Seoul National University College of Medicine (Republic of Korea), has found that higher circulating levels of bilirubin were inversely associated with the risk of colorectal cancer among adults in the Republic of Korea. Bilirubin is a breakdown product of red blood cells and is one of the most potent endogenous antioxidants in humans. Bilirubin levels are under strong genetic control but are also influenced by environmental factors (e.g. prolonged fasting, physical activity) and are abnormally high in people with liver diseases.

In this prospective Korean Genome and Epidemiology Study-Health Examinee (KoGES-HEXA) cohort study, pre-diagnostic serum levels of bilirubin were measured in 78 467 adults aged 40–78 years at recruitment. After a median follow-up of 7.9 years, 539 incident cases of colorectal cancer were recorded. In multivariable-adjusted models, higher serum levels of bilirubin were associated with a 26% (confidence interval, 42% to 7%) lower risk of colorectal cancer, comparing the highest with the lowest tertile (P value for linear trend = 0.003).

These results support further studies on repurposing bilirubin as a low-cost biomarker for colorectal cancer risk stratification. Accurate risk stratification is important clinically and for the cost-effectiveness of screening programmes. Given the high incidence of colorectal cancer and the low participation rates in population-based screening, even a small improvement in risk prediction could have a meaningful impact and is worth exploring.

Noh H, Lee J, Seyed Khoei N, Peruchet-Noray L, Kang D, Fervers B, et al.
Serum bilirubin levels and risk of colorectal cancer in Korean adults: results from the Korean Genome and Epidemiology Study-Health Examinee (KoGES-HEXA) Cohort Study
Br J Cancer. Published online 8 October 2024;
https://doi.org/10.1038/s41416-024-02847-9

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