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Early/missed colorectal cancers common among older patients with IBD
Older patients with inflammatory bowel disease were at elevated risk for early or missed colorectal cancers following colonoscopy, according to recent results.
Researchers evaluated data from 55,008 patients aged 67 years or older in the Surveillance, Epidemiology and End-Results Medicare-linked database. All participants had been diagnosed with colorectal cancer (CRC) between 1998 and 2005, within 36 months of colonoscopy. The cohort included 304 patients with Crohn’s disease (CD) and 544 with ulcerative colitis (UC). CRC diagnosed between 6 and 36 months of colonoscopy was defined as early/missed CRC; when diagnosed within 6 months of the procedure, CRC was considered detected CRC.
Researchers identified 3,589 early/missed CRCs, including 3,432 among those without IBD, 54 among patients with CD and 103 in those with UC. The rate of early/missed CRCs was 15.1% among patients with CD, 15.8% of those with UC and 5.8% of those without IBD (P<.001 for comparisons with non-IBD).
Investigators noted that early/missed CRCs were less likely to be located in the right colon in patients with IBD than in those without (54% of CRCs in those with CD; 52.1% in those with UC, vs. 68.4% in those without IBD, P<.001 for comparisons with non-IBD).
Multivariate analysis indicated increased risk for early/missed CRC in patients with either CD (OR=3.07, 2.23-4.21) or UC (OR=3.05, 2.44-3.81) compared with IBD-free patients. Other factors associated with increased early/missed CRC risk included female sex (OR=1.12, 1.05-1.21), family history of CRC (OR=1.64, 1.41-1.92), history of colon polyps (OR=4.02, 3.57-4.53) and undergoing colonoscopy performed by a non-gastroenterologist (OR=1.12, 1.04-1.21). Investigators noted an inverse association between early/missed CRC risk and inpatient colonoscopy (OR=0.50, 0.45-0.54 vs. outpatient procedures) (95% CI for all).
“In this population-based analysis … we found that the rate of early/missed CRCs among older IBD patients was three times as high as older non-IBD patients,” the researchers wrote. “This finding provides additional evidence to support intensive surveillance colonoscopy for older IBD patients, as recommended by current guidelines.”