MedWire News: The risk for colorectal cancer in patients with inflammatory bowel disease (IBD) has not increased in recent years, and has not worsened with the use of immunomodulators and biologic drugs, suggest study findings.
During a presentation at Digestive Disease Week in Chicago, Illinois, USA, Michael Kappelman (University of North Carolina, Chapel Hill, USA) reported that the standardized incidence ratio (SIR) for any invasive cancer among patients with Crohn's disease or ulcerative colitis (UC) remained stable at 1.2 for both 1978-1993 and 1994-2008.
The findings are of importance, as the widespread use of immune-modifying drugs has been thought to increase the risk for extra-intestinal malignancies in IBD patients, said Kappelman.
In total, 12,980 cases of CD and 22,481 cases of UC were identified using the Danish National Registry of Patients, covering all Danish hospitals from 1978 through 2008. Patients were followed-up for an average 9.4 and 11.2 years for CD and UC, respectively.
For cancer types occurring in five or more patients, SIRs were used to compare the rate of a given cancer in IBD patients to the expected incidence of that cancer in the general population.
In total, 1212 and 2509 cancers occurred in CD and UC patients, giving overall SIRs of 1.4 and 1.2, respectively.
CD was significantly associated with a number of cancers, with SIRs ranging from 1.7 to 3.4 for cancer of the small intestine, myeloid leukemia, myelodysplasia, hematological malignancy, gallbladder cancer, non-Hodgkin's lymphoma, colon cancer, lung cancer, basal-cell skin cancer, and other non-melanoma skin cancer.
For UC, SIRs ranged from 1.3 to 2.9 for cancers of the gallbladder, anal canal, testicle, liver, rectum, colon, non-Hodgkin's lymphoma, and basal-cell skin cancer.
It was shown that incidence of cancers of the small and large intestine fell from a SIR of 4.4 during 1978-1987 to 2.1 during 1998-2009.
Kappelman reported that the factor most strongly associated with any cancer development was the age at which patients were diagnosed with IBD. Patients who were diagnosed with CD before 19 years of age had a SIR of 2.5, while those diagnosed with UC by 19 years of age had a SIR of 2.2.
"Overall, we found a 50% increase in risk for cancer in these patients, but the risk has not increased in recent years, which suggests that these associations are for IBD itself rather than changes in medical treatment," concluded Kappelman.
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