Gastroenterology

Gastroenterology

Volume 130, Issue 4, April 2006, Pages 1039-1046
Gastroenterology

Clinical–alimentary tract
Risk of Intestinal Cancer in Inflammatory Bowel Disease: A Population-Based Study From Olmsted County, Minnesota

Presented in part at the 106th Annual Meeting of the American Gastroenterological Association, May 14–19, 2005, Chicago, Illinois (Gastroenterology 2005;128(Suppl 2):A321).
https://doi.org/10.1053/j.gastro.2005.12.037Get rights and content

Background & Aims

The risk for colorectal cancer in Crohn’s disease and ulcerative colitis patients from the United States currently is unknown. We estimated the risk for small-bowel and colorectal cancer in a population-based cohort of 692 inflammatory bowel disease patients from Olmsted County, Minnesota, from 1940 to 2001.

Methods

The Rochester Epidemiology Project was used to identify cohort patients with colorectal and small-bowel cancer. The cumulative probability of cancer and standardized incidence ratios (SIR) were estimated using expected rates from Surveillance, Epidemiology, and End Results, white patients from Iowa, from 1973 to 2000, and Olmsted County, from 1980 to 1999.

Results

Colorectal cancer was observed in 6 ulcerative colitis patients vs 5.38 expected (SIR, 1.1; 95% confidence interval [CI], 0.4–2.4), but 4 of these occurred among those with extensive colitis or pancolitis (SIR, 2.4; 95% CI, 0.6–6.0). Six Crohn’s disease patients (vs 3.2 expected) developed colorectal cancer (SIR, 1.9; 95% CI, 0.7–4.1). Three Crohn’s disease patients developed small-bowel cancer vs 0.07 expected (SIR, 40.6; 95% CI, 8.4–118).

Conclusions

The risk for colorectal cancer was not increased among ulcerative colitis patients overall, but appeared to be increased among those with extensive colitis. The colorectal cancer risk was increased slightly among Crohn’s disease patients, who also had a 40-fold excess risk for small-bowel cancer.

Section snippets

Patient Population

A total of 692 Olmsted County, Minnesota, residents (378 UC, 314 CD) first were diagnosed with IBD in Olmsted County, Minnesota, during the period from 1940 to 2001, according to previously established well-defined criteria.22, 23, 24 Olmsted County, situated in southeastern Minnesota, had a population of 124,277 inhabitants in the 2000 US census. The majority of people reside in Rochester, which is the urban center of an otherwise rural county. Eighty-nine percent are non-Hispanic white and a

Results

The 692 IBD patients were followed up for a total of 10,470 person-years (median follow-up period, 14 years; range, 0–58 years). However, only 10,019 person-years occurred before total proctocolectomy and were available for analysis of CRC risk. A total of 118 patients (17%) died within the study period.

A total of 378 patients (44% women) with UC were followed up for a total of 5567 person-years (median follow-up period, 12.6 years; range, 0.0–57.6 years) before proctocolectomy. The median age

Discussion

In this population-based study from North America, the CRC risk among UC patients overall was similar to that expected in the general population. Among patients with extensive colitis, the CRC risk was increased 2-fold, although this did not meet statistical significance. In CD, the risk for CRC was somewhat increased overall, but was not statistically significant. In a subset of male CD patients with young age at diagnosis, the CRC risk was increased. The risk for small-bowel cancer in the CD

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  • Cited by (0)

    Supported by the Mayo Foundation for Medical Education and Research, AR30582 from the National Institutes of Health, the Astra Zeneca Travel Foundation (visit to Mayo Clinic by T.J.), Augustinus Foundation, Beckett Foundation, Danish Crohn Colitis Foundation, Jacob Madsen and Olga Madsen Foundation, and Sigrid R. Moran Foundation.

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