Is Inflammatory Bowel Disease an Important Risk Factor Among Older Persons with Colorectal Cancer in the United States? A Population-Based Case–Control Study

  • Aasma ShaukatEmail author
  • Daniel J. Virnig
  • Nadim I. Salfiti
  • David H. Howard
  • Shanthi V. Sitaraman
  • Jonathan M. Liff
Original Article



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.


Ulcerative colitis Colorectal cancer 


Conflict of interest

No conflicts of interest exist for any of the authors.


  1. 1.
    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.PubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–535.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Prior P, Gyde SN, Macartney JC, Thompson H, Waterhouse JA, Allan RN. Cancer morbidity in ulcerative colitis. Gut. 1982;23:490–497.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Heuschen UA, Hinz U, Allemeyer EH, et al. Backwash ileitis is strongly associated with colorectal carcinoma in ulcerative colitis. Gastroenterology. 2001;120:841–847.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    Itzkowitz SH, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases. Gastroenterology. 2004;126:1634–1648.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Stonnington CM, Phillips SF, Zinsmeister AR, Melton LJ III. Prognosis of chronic ulcerative colitis in a community. Gut. 1987;28:1261–1266.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 60:277–300.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Aasma Shaukat
    • 1
    Email author
  • Daniel J. Virnig
    • 1
  • Nadim I. Salfiti
    • 1
  • David H. Howard
    • 2
  • Shanthi V. Sitaraman
    • 3
  • Jonathan M. Liff
    • 4
  1. 1.Section of Gastroenterology, Department of MedicineVA Medical Center and University of MinnesotaMinneapolisUSA
  2. 2.Department of Health, Policy & ManagementRollins School of Public Health, Emory UniversityAtlantaUSA
  3. 3.Division of Digestive Diseases, Department of MedicineEmory UniversityAtlantaUSA
  4. 4.Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaUSA

Personalised recommendations