Systematic review with meta‐analysis: the declining risk of colorectal cancer in ulcerative colitis

Castaño-Milla, Carlos; Chaparro, María; Gisbert, Javier P.

doi:10.1111/apt.12651

Cited by 230 publications

(136 citation statements)

References 125 publications

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“…Likewise, the population-based Dutch cohort of UC patients diagnosed during 1991-2011 demonstrated a decreased risk of CRC in UC patients compared to that of the background population (SIR 0.45, 95% CI 0.19-0.88) [23] . Finally, a meta-analysis of both population-based and referral-centre studies showed a decreasing trend in CRC in UC patients according to the decade of the publication year [24] . The risk of CRC dropped from 4.29/1,000 person years disease duration (PYD) in studies published in 1950s to slightly over 1.20/1,000 PYD in publications at or after the year 2000.…”

Section: Ulcerative Colitismentioning

confidence: 97%

“…Risk factors of CRC include disease extension, young age at diagnosis, disease duration, positive family history of CRC and presence of primary sclerosing cholangitis (PSC) [20,21,24,25] . According to 2 meta-analyses of population-based studies, patients with extensive colitis had 4.8-and 6.9-fold increased risk of CRC than healthy population, while individuals with proctitis had the same risk as that of the background population [20,21] .…”

Section: Ulcerative Colitismentioning

confidence: 99%

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What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Ďuricová

2017

Dig Dis

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Background: Population-based studies represent the whole spectrum of patient population and should represent the mainstay when evaluating patients' prognosis. A high number of CD patients need surgical intervention during the disease course. The disease course of inflammatory bowel diseases, including ulcerative colitis (UC) and Crohn's disease (CD), is quite varied and still quite unpredictable. Key Messages: According to earlier studies, up to 60% of patients undergo at least one operation after 10 years of CD duration. Newer cohorts report lower cumulative probability of surgery of approximately 40% after 10 years. The colectomy rate in UC is approximately 10% after 10 years from diagnosis with a geographic difference. Similarly to CD, the colectomy rate seems to decrease over time. There is some evidence that the increasing use of immunosuppressive and/or biological therapy might have been responsible for this favourable trend. However, other factors may have an impact on decreasing surgical trend over time. The relative risk (RR) of colorectal cancer (CRC) in UC is approximately doubled compared to background population. However, the absolute risk in general is relatively low between 1.1 and 5.3% after 20 years of disease duration. Furthermore, a decreasing trend in the incidence of CRC has been reported in recent studies. Importantly, several factors such as disease extent, activity, age at UC onset, and so on may increase/modify an individual risk. Similar to UC, CD patients have approximately 2 times higher RR of cancer compared to background population. The risk is higher for colon than for rectum cancer and present only in CD patients with colonic involvement. Conclusions: The surgery rate in CD has decreased over the time period. The evidence on colectomy rate in UC is less conclusive. The RR of CRC in UC and CD is approximately doubled compared to that of the background population, but it seems to be decreasing in more recent cohorts.

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Section: Ulcerative Colitismentioning

confidence: 97%

Section: Ulcerative Colitismentioning

confidence: 99%

What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Ďuricová

2017

Dig Dis

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“…The most recent meta-analysis of CRC, which was published in 2014, found that the overall risk of CRC in 181,923 UC patients was 1.69/1,000/year; this risk was 0.91/1,000/year in the first decade after the diagnosis of UC, 4.07/1,000/year in the second decade and 4.55/1,000/year in the third decade [1]. These rates are lower than those reported by a meta-analysis published in 2001 [2]: 3/1,000/year overall and 2, 8 and 18% in the first, second and third decades after diagnosis, respectively.…”

Section: Epidemiology Of Ibd-associated Crcmentioning

confidence: 99%

“…As mentioned above, two meta-analyses [1,2] from different time periods suggest that the incidence of IBD-associated CRC is in decline. A cohort study conducted in Denmark between 1962 and 1987 reported only 13 cases of CRC among 1,160 UC patients [24].…”

Section: Factors Protecting Against Ibd-associated Crcmentioning

confidence: 99%

Colorectal Cancer in Inflammatory Bowel Disease: Epidemiology, Pathogenesis and Surveillance

Wang¹,

Fang²

2014

Gastrointest Tumors

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Background: Inflammatory bowel disease (IBD; including ulcerative colitis and Crohn's disease) is associated with an increased risk for colorectal cancer (CRC). Chronic mucosal inflammation is a key factor in the onset of carcinogenesis in IBD patients. Although most gene alterations that cause sporadic CRCs also occur in patients with IBD-associated CRC, some gene sequences and mutation frequencies differ between sporadic CRCs and IBD-associated CRCs. Summary: This review explores the incidence of CRC in IBD patients, with the goal of identifying the risk and protective factors for CRC in order to facilitate dysplasia management via individualized surveillance strategies. Key Message: The incidence of CRC is higher among IBD patients. Identifying the risk and protective factors for CRC will facilitate dysplasia management via individualized surveillance strategies. Practical Implications: Several risk factors, including active inflammation, the coexistence of primary sclerosing cholangitis, a family history of sporadic CRC and the extent and duration of colonic disease, can lead to the development of CRC in patients with IBD. These risk factors should be utilized in individualized surveillance strategies to lower CRC incidence among IBD patients. Use of 5-aminosalicylic acid may play an important role in CRC prevention. Until newer, more reliable markers of IBD-associated CRC risk are found, dysplasia will continue to be the best marker of CRC risk in IBD. Dysplasia management continues to play a key role in preventing the progression of carcinogenesis.

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“…The incidence of IBD-associated CRC is indeed decreasing over time as a likely consequence of the considerable efforts in recent decades directed at lowering CRC risk in patients with IBD [1]. Surveillance colonoscopy is often credited with this reduction, likely due to improvements at detecting and removing precancerous dysplastic lesions, particularly with the assistance of high definition and enhanced imaging technology.…”

mentioning

confidence: 99%

Prognosis of Colorectal Cancer in Inflammatory Bowel Disease: Data from a State Registry

Ullman

Itzkowitz

2017

Dig Dis Sci

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Systematic review with meta‐analysis: the declining risk of colorectal cancer in ulcerative colitis

Abstract: SUMMARY BackgroundPatients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC); however, the magnitude of this effect is open to debate.

Cited by 230 publications

References 125 publications

What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Colorectal Cancer in Inflammatory Bowel Disease: Epidemiology, Pathogenesis and Surveillance

Prognosis of Colorectal Cancer in Inflammatory Bowel Disease: Data from a State Registry

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