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Ulcerative colitis in men linked to increased risk for pancreatic cancer
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2010 Digestive Disease Week
Patients with inflammatory bowel disease had six times the risk for developing pancreatic neoplasia, and men with ulcerative colitis had five times the risk for developing pancreatic neoplasia in a prospective study of more than 2,800 patients.
Because there is a known association between inflammatory bowel disease (IBD) and primary sclerosing cholangitis and cholangiocarcinoma within the bile ducts, as well as between primary sclerosing cholangitis and pancreatic cancer, researchers suspected that patients with IBD would be at greater risk for the development of pancreatic cancer.
To test their supposition, researchers prospectively examined 2,877 adults with IBD who were treated in the University of Utah Health System from January 1996 to December 2006. The IBD cohort was then matched to the Utah Cancer Registry and the Utah Population Database to determine the number of patients diagnosed with IBD and pancreatic cancer.
Jason Schwartz, MD, assistant professor of surgery at the University of Utah, presented the results Sunday at Digestive Disease Week 2010. He said IBD was much more closely linked to pancreatic cancer than researchers had expected.
“We thought there would be an association, but we were somewhat surprised by the strength of the association,” Schwartz said. “In our patient cohort of over 2,800 patients, we found that patients with inflammatory bowel disease had a standardized incidence rate of acquiring pancreatic cancer of 3.36. This is three times that of the general population.”
He said researchers expected to find 9.5 incidences of a dual diagnosis of IBD and pancreatic cancer per 100,000 person-years in Utah. They found 12 patients diagnosed with IBD and pancreatic cancer in only 15,784 person-years; however, five patients were excluded from the study because their diagnosis of cancer preceded their diagnosis of IBD.
Researchers expected to find 0.97 diagnoses of pancreatic cancer among women with IBD in 8,158 person-years. Instead, they found none. All diagnoses of pancreatic cancer occurred in men in the ulcerative colitis subgroup.
Among men with IBD, researchers expected to find 1.16 diagnoses of pancreatic cancer in 1,625 person-years. Instead, there were seven incidences of men with IBD being diagnosed with pancreatic cancer, representing an SIR of 6.22 (95% CI, 2.96-13.06).
Similarly, researchers found no cases in which women with ulcerative colitis were later diagnosed with pancreatic cancer. In men with ulcerative colitis, researchers expected to find 1.5 cases in 10,046 person-years in which patients were diagnosed with pancreatic cancer. There were seven men diagnosed with both diseases, for an SIR of 4.85 (95% CI, 2.31-10.19).
Schwartz said the importance of these results should not be overestimated because they need to be validated and may not hold nationwide.
“It’s too early to make any specific screening recommendations. This is just a piece of the larger puzzle,” he said. “In breast cancer, we’re currently able to take a person’s family history and personal history and craft that into a risk assessment of the likelihood that individual will develop breast cancer. We’re in the infancy in doing that in pancreatic cancer.” – by Jason Harris
At this point, it is way too early to tell patients who have ulcerative colitis, in particular, to worry about this. If you’re in the South, if you’re African-American, if you’re a smoker, if you have a first-degree relative with pancreatic cancer and now if you have ulcerative colitis, eventually, this may go into a risk algorithm that will help us. But right now, patients need to talk to their physician to understand their particular risk factors. It is way too early to make recommendations based on these findings.
– Craig P. Fischer, MD, MPH
Assistant
Professor of Surgery, The Methodist Hospital, Houston
For more information:
- Martin T. #252. Inflammatory Bowel Disease and Pancreatic Cancer: a Prospective Cohort Study. Presented at: the 2010 Digestive Disease Week; May 1-6, 2010; New Orleans.
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