Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

Abstract

ObjectiveThe association between ulcerative colitis (UC) and colorectal cancer (CRC) is widely accepted, although attenuated risk has been reported in recent years. Colonoscopic surveillance is recommended with intervals based on established clinical risk factors. Nevertheless, a significant number of patients develop interval cancers, indicating the need of improved individualised assessment. In the present study, we evaluated clinical risk factors associated with CRC during a prescheduled follow-up 20 years after diagnosis, the IBSEN study.DesignA population-based inception cohort of patients diagnosed with inflammatory bowel disease from 1 January 1990 until 31 December 1993, prospectively followed at 1, 5, 10 and 20 years after diagnosis. A total of 517 patients with UC were included; 264 (51 %) men; median age at inclusion 37.4 years (4–88).ResultsThe overall incidence of CRC was 1.6% (8/517) at a 20-year follow-up. The total lifetime risk of CRC prior to or after UC diagnosis was 2.3%. (12/517). Patients older than 70 years at diagnosis had a 15-fold higher risk of CRC compared with those diagnosed when younger than 40 years, with HR 15.68 (95% CI: 1.31 to 187.92). Neither sex, first-degree relative with CRC, extent of colitis nor primary sclerosing cholangitis affected the risk of CRC.ConclusionThe risk of CRC in UC was low and comparable with the risk of CRC in the background population of Norway.

Editorial: missed opportunities to detect colorectal cancer in inflammatory bowel disease—getting to the root. Authors’ reply

“…The editorial writers also highlight our finding that the incidence of IBD‐associated CRC, adjusted for population changes, has remained static. This contrasts with studies from Nordic countries that have reported declining colorectal cancer incidence rates 3,4 . We suspect this reflects more limited electronic integration of primary and secondary care records in the UK, compared to Nordic countries.…”

“…This contrasts with studies from Nordic countries that have reported declining colorectal cancer incidence rates. 3,4 We suspect this reflects more limited electronic integration of primary and secondary care records in the UK, compared to Nordic countries.…”

Effective immune-inflammation index for ulcerative colitis and activity assessments

“…The overall prevalence exceeds 0.3% in North America, Oceania, and most European countries[ 2 ]. Inflammatory bowel disease (IBD) is the third highest risk factor for colorectal cancer (CRC), and 18% of IBD-related CRC cases occur in patients with a history of less than 8 years[ 3 ]. Cross-sectional imaging under endoscopy may accurately reflect current inflammation of the intestines.…”

Root‐cause analyses of missed opportunities for the diagnosis of colorectal cancer in patients with inflammatory bowel disease

“…Based on our findings and those from another recent study that used primary care records to identify cases and thereby control for tertiary centre bias, the incidence of CRC in IBD appears to be static 14,22,23 . It is contrary, however, to data from specialist endoscopy centres and from prospective population studies from Nordic countries that have reported falling CRC incidence rates 24–27 . It is unclear why CRC rates have fallen in Denmark, Norway and Sweden but not the UK over a similar timeframe, since it is likely that all four countries have adopted similar treatment‐targets: including the maintenance of remission with medical therapies, appropriately timed surgeries and the use of colorectal surveillance programmes 23,28–30 .…”

“…14,22,23 It is contrary, however, to data from specialist endoscopy centres and from prospective population studies from Nordic countries that have reported falling CRC incidence rates. [24][25][26][27]…”