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Pediatric-onset IBD increased cancer, not mortality risk
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The risk for death was not significantly greater than the general population among patients with pediatric-onset inflammatory bowel disease, but cancer risk was increased threefold in a recent study.
Researchers evaluated 698 patients with IBD listed in the EPIMAD registry, including 538 patients with Crohn’s disease (CD) and 160 with ulcerative colitis (UC). All participants were diagnosed between 1988 and 2004 in northern France, were aged younger than 17 years at diagnosis (median age, 14.6 years) and underwent a median follow-up of 11.4 years.
Six participants died during follow-up, including five with CD and one with UC, for a mortality rate of 0.84%. Mortality risk within the cohort did not differ significantly from the reference population either before (P=.27) or after exclusion of one patient who died in an automobile accident. (P=.08).
Cancer developed in nine patients (1.3%), including six patients with CD and three with UC. Cases included two patients with colon cancer, two with basal cell carcinomas, one with cholangiocarcinoma and one case each of acute leukemia, small bowel carcinoid and cancer of the prepuce and uterine cervix. Investigators said four of the cancer patients had been treated with immunosuppressants; three patients also received anti-tumor necrosis factor-alpha therapy.
Regardless of age or sex, risk for cancer was significantly elevated (standardized IR=3.0; 95% CI, 1.3-5.9), and the cumulative probability of developing cancer was 3.7% during 17 years of follow-up. In particular, risk for colon cancer was significantly greater (SIR=45.7; 95% CI, 5.5-165.3), while basal cell carcinoma risk was not (SIR=6.2; 95% CI, 0.8-22.3).
“Despite its overall reassuring message, this study should remind clinicians about the increased risk of cancer, which is especially worrisome in pediatric IBD, and the need for simple preventive measures such as endoscopic surveillance of the colon and protection against ultraviolet radiation with lifelong dermatologic screening in patients exposed to thiopurines and anti-TNFs,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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