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Patients with IBD at greater risk for postcolonoscopy colorectal cancer
Patients with inflammatory bowel disease experience higher rates of postcolonoscopy colorectal cancer, a risk that is higher among younger patients with ulcerative colitis and an additional risk for rectal cancers among those with Crohn’s disease, , according to research published in Gut.
Anna M. Forsberg, PhD, of the department of medicine at Karolinska Institutet in Stockholm, Sweden, and colleagues wrote that although this group of patients undergoes many colonoscopies, little is known about rates of postcolonoscopy CRC (PCCRC) in the population.
“Studies on elderly American patients with IBD and those previously hospitalized for their IBD in England showed an increased risk of a CRC to be a PCCRC,” they wrote. “To our knowledge, there has been no national studies on PCCRC in an entire adult IBD population.”
Forsberg and colleagues analyzed data from a Swedish population-based cohort study of patients who underwent colonoscopy between 2001 and 2010. They identified patients who were diagnosed with CRC within 36 months after colonoscopy and categorized them into three groups; CD (n = 14,597), UC (n = 26,513), and non-IBD (n = 229,808).
Researchers identified 13,317 CRCs in the non-IBD group, 133 in the CD group and 281 in the UC group and determined that the PCCRC rate was 28.3% among patients with CD and 41% in patients with UC.
The risk for PCCRC was greater in CD (RR = 3.82; 95% CI, 2.94–4.96) and UC (RR = 5.89; 95% CI, 5.1–6.8) compared with the non-IBD population. The risk was highest for rectal cancer in patients with CD and among younger patients with UC.
“In the UC group, we noticed a nearly linear negative correlation (r = 0.96, P < .001) between age and rate of PCCRC: the younger the individual, the higher the rate of PCCRC,” they wrote.
Forsberg and colleagues wrote that their findings suggest more needs to be done to improve screening and surveillance strategies in patients with IBD.
“The high rates in the more advanced stages could indicate that these PCCRCs truly represent missed lesions at the index or surveillance colonoscopy, highlighting the need for finding better surveillance strategies,” they wrote. “The high rates of PCCRC in young patients with UC and for rectal cancers in CD might affect the way we employ surveillance in the IBD group in the future.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.