Is Inflammatory Bowel Disease an Important Risk Factor Among Older Persons with Colorectal Cancer in the United States? A Population-Based Case–Control Study
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While ulcerative colitis (UC) and Crohn’s disease (CD) are thought to predispose to colorectal cancer (CRC), the association has not been well studied in an older population.
The objective of our study was to evaluate the association of ulcerative colitis and Crohn’s disease and colorectal cancer in a population-based, case–control study. We also wished to estimate the incidence rates of colorectal cancer among older individuals with UC/CD.
All cases of colorectal cancer in persons 67 and older in the SEER catchment area and in the Medicare claims database were compared with cancer-free controls residing in the same geographic area. We used multivariable logistic regression models adjusted for demographic and other factors.
We identified 47,543 cases of CRC and 142,273 controls. We found a modest association between UC and CRC (OR 1.93; 95% CI 1.54–2.49; P-value < 0.001) and a significant, albeit modest, association between CD and CRC (OR 1.45; 95% CI 1.08–1.91; P-value 0.01). We found the incidence of CRC to be 8.2 per 10,000 person-years (95% CI 6.5–10.1/10,000 person-years) among those with UC/CD, and 6.1 per 10,000 person-years (95% CI 4.6–7.8/10,000 person-years) among those without UC/CD, resulting in an incidence rate ratio of 1.34.
Among older persons ulcerative colitis and Crohn’s disease are modest risk factors for CRC, and the incidence rate ratio for CRC is modest, suggesting that risk of CRC in patients with IBD may be lower than previously thought.
- Cotton S, Sharp L, Little J, Cotton S, Sharp L, Little J. The adenoma-carcinoma sequence and prospects for the prevention of colorectal neoplasia. Crit Rev Oncog. 1996;7:293–342.
- Burmer GC, Rabinovitch PS, Haggitt RC, et al. Neoplastic progression in ulcerative colitis: histology, DNA content, and loss of a p53 allele. Gastroenterology. 1992;103:1602–1610.
- Lindberg JO, Stenling RB, Rutegard JN, Lindberg JO, Stenling RB, Rutegard JN. Eighteen-year surveillance of dysplasia-associated lesion in ulcerative colitis. Endoscopy. 2000;32:359–360. CrossRef
- Odze RD, Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol. 1999;94:1746–1750. CrossRef
- Fogt F, Alsaigh N, Fogt F, Alsaigh N. Polypoid dysplasias in ulcerative colitis and sporadic adenomas: genetic approach to the differential diagnosis (review). Oncol Rep. 1999;6:721–725.
- Blackstone MO, Riddell RH, Rogers BH, et al. Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. Gastroenterology. 1981;80:366–374.
- Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–535. CrossRef
- Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001;91:854–862. CrossRef
- Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. 1990;323:1228–1233. CrossRef
- Askling J, Dickman PW, Karlen P, et al. Family history as a risk factor for colorectal cancer in inflammatory bowel disease. Gastroenterology. 2001;120:1356–1362. CrossRef
- Kornfeld D, Ekbom A, Ihre T. Is there an excess risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study. Gut. 1997;41:522–525. CrossRef
- Prior P, Gyde SN, Macartney JC, Thompson H, Waterhouse JA, Allan RN. Cancer morbidity in ulcerative colitis. Gut. 1982;23:490–497. CrossRef
- Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology. 2004;126:451–459. CrossRef
- Heuschen UA, Hinz U, Allemeyer EH, et al. Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis. Gastroenterology. 2001;120:841–847. CrossRef
- Eaden J, Abrams K, Ekbom A, Jackson E, Mayberry J. Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther. 2000;14:145–153. CrossRef
- Velayos FS, Loftus EV Jr, Jess T, et al. Predictive and protective factors associated with colorectal cancer in ulcerative colitis: a case-control study. Gastroenterology. 2006;130:1941–1949. CrossRef
- Jess T, Gamborg M, Matzen P, Munkholm P, Sorensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol. 2005;100:2724–2729. CrossRef
- Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40:IV-3-18.
- Lakatos L, Mester G, Erdelyi Z, et al. Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study. Inflamm Bowel Dis. 2006;12:205–211. CrossRef
- Itzkowitz SH, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases. Gastroenterology. 2004;126:1634–1648. CrossRef
- Jess T, Loftus EV Jr, Velayos FS, et al. Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted county, Minnesota. Gastroenterology. 2006;130:1039–1046. CrossRef
- Winther KV, Jess T, Langholz E, Munkholm P, Binder V. Long-term risk of cancer in ulcerative colitis: a population-based cohort study from Copenhagen County. Clin Gastroenterol Hepatol. 2004;2:1088–1095. CrossRef
- Stonnington CM, Phillips SF, Zinsmeister AR, Melton LJ III. Prognosis of chronic ulcerative colitis in a community. Gut. 1987;28:1261–1266. CrossRef
- Cooper GS, Yuan Z, Landefeld CS, Johanson JF, Rimm AA. A national population-based study of incidence of colorectal cancer and age. Implications for screening in older Americans. Cancer. 1995;75:775–781. CrossRef
- Nelson RL, Dollear T, Freels S, Persky V. The relation of age, race, and gender to the subsite location of colorectal carcinoma. Cancer. 1997;80:193–197. CrossRef
- Tavani A, Fioretti F, Franceschi S, et al. Education, socioeconomic status and risk of cancer of the colon and rectum. Int J Epidemiol. 1999;28:380–385. CrossRef
- Shipp MP, Desmond R, Accortt N, Wilson RJ, Fouad M, Eloubeidi MA. Population-based study of the geographic variation in colon cancer incidence in Alabama: relationship to socioeconomic status indicators and physician density. South Med J. 2005;98:1076–1082. CrossRef
- Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 60:277–300.
- Is Inflammatory Bowel Disease an Important Risk Factor Among Older Persons with Colorectal Cancer in the United States? A Population-Based Case–Control Study
Digestive Diseases and Sciences
Volume 56, Issue 8 , pp 2378-2383
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Ulcerative colitis
- Colorectal cancer
- Industry Sectors
- Author Affiliations
- 1. Section of Gastroenterology, Department of Medicine, VA Medical Center and University of Minnesota, Gastroenterology Section 111-D, 1- Veterans Drive, Minneapolis, MN, 55417, USA
- 2. Department of Health, Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- 3. Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
- 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA