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Risk of Early Colorectal Cancers Needs to Be Considered in Inflammatory Bowel Disease Care

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Abstract

Background

Current guidelines recommend starting colorectal cancer (CRC) surveillance 8–10 years after inflammatory bowel disease (IBD) onset. Recent studies report that the incidence of CRC within 8–10 years of IBD onset (i.e., early CRC) ranges from 12 to 42%.

Aims

To describe the current prevalence of early CRC in a tertiary care center IBD cohort with CRC and to identify associated risk factors.

Methods

We performed a single-center observational study of IBD patients diagnosed with CRC from 2005 to 2015. We compared characteristics of patients with early CRC (diagnosis of CRC within 8 years of initial IBD onset) to those with CRC diagnosed later in their IBD course.

Results

Ninety-three patients met inclusion criteria. Eleven (11.8%) patients developed CRC within 8 years of initial IBD onset. On multivariable logistic regression, age greater than 28 at IBD onset (adjusted OR 12.0; 95% CI 2.30, 62.75) and tobacco use (adjusted OR 8.52; 95% CI 1.38, 52.82) were significant predictors of early CRC. A validation cohort confirmed calibration and discrimination of the model.

Conclusions

One out of every eight IBD patients with CRC developed their malignancy prior to the currently recommended timeframe for the initiation of surveillance colonoscopy. IBD onset at 28 years or older and tobacco use were identified as predictors of early CRC. Early CRC should be considered in discussions of cancer surveillance in this population. Prospective cohort studies are necessary to further analyze the impact of early CRC in IBD.

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Acknowledgments

This work was supported by the National Center for Advancing Translational Science of the National Institute of Health (UL1TR000457).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Michigan Medicine, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI, 48109, USA

    Shirley Cohen-Mekelburg

  2. Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA

    Yecheskel Schneider

  3. Department of Medicine, NewYork Presbyterian Weill Cornell Medicine, New York, NY, USA

    Stephanie Gold & Gaurav Ghosh

  4. Division of Gastroenterology and Hepatology, NewYork Presbyterian Weill Cornell Medicine, New York, NY, USA

    Russell Rosenblatt, Kaveh Hajifathalian, Ellen Scherl, Felice Schnoll-Sussman & Philip Katz

  5. Division of Gastroenterology and Hepatology, Mount Sinai Hospital, New York, NY, USA

    Adam Steinlauf

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  1. Shirley Cohen-Mekelburg
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Contributions

Shirley Cohen-Mekelburg, Yecheskel Schneider, Stephanie Gold, Gaurav Ghosh, and Adam Steinlauf were involved in the study concept and design, data management, statistical analysis and interpretation of data, drafting of manuscript, and critical revisions. In addition, Shirley Cohen-Mekelburg and Adam Steinlauf were involved in study supervision. Ellen Scherl, Philip Katz, Felice Schnoll, Kaveh Hajifathalian, and Russell Rosenblatt were involved in interpretation of data and critical revisions. All authors approved the final version of the article, including the authorship list.

Corresponding author

Correspondence to Shirley Cohen-Mekelburg.

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Conflict of interest

ES has received grant/research support from Abbott Laboratories (AbbVie), AstraZeneca, Janssen Research & Development, and Pfizer and serves as a consultant to AbbVie, Janssen Pharmaceutical, and Takeda Pharmaceuticals. The other authors have no relevant conflicts of interest to disclose.

Ethical approval

This study was reviewed and approved by the institutional review board (IRB# 1605017219).

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Cohen-Mekelburg, S., Schneider, Y., Gold, S. et al. Risk of Early Colorectal Cancers Needs to Be Considered in Inflammatory Bowel Disease Care. Dig Dis Sci 64, 2273–2279 (2019). https://doi.org/10.1007/s10620-019-05554-1

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  • DOI: https://doi.org/10.1007/s10620-019-05554-1

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