Risk of Cancer in Inflammatory Bowel Disease: Going up, Going Down, or Still the Same?

Sushil K. Garg; Edward V. Loftus Jr

Disclosures

Curr Opin Gastroenterol. 2016;32(4):274-281. 

In This Article

Abstract and Introduction

Abstract

Purpose of review There has been increasing use of immunosuppressive medications as well as better surveillance techniques in inflammatory bowel disease (IBD), which is associated with an increased risk of intestinal and extraintestinal malignancies. We assessed the temporal trends of cancer incidence in IBD patients by reviewing the biomedical literature, performing meta-regression of existing studies, and examining trends in hospitalizations for cancer in IBD patients using a national hospitalization database.

Recent findings The overall risk of colorectal cancer in ulcerative colitis has decreased in the last 3 decades. The risk of small bowel cancer is significantly elevated among Crohn's disease patients, but there has been no change in incidence rates. The overall risk of non-Hodgkin lymphoma has increased over the last 16 years, and IBD patients on thiopurines and antitumor necrosis factor agents are at increased risk of non-Hodgkin lymphoma. The risk of melanoma in IBD patients is increased, with no significant change over time. The risk of nonmelanoma skin cancer is higher in patients using thiopurines compared with the non-IBD background population, with no significant change over time.

Summary This study points toward a decrease in the incidence of colorectal cancer in ulcerative colitis patients, but an increase in the incidence of lymphoproliferative disorders and nonmelanoma skin cancers with the use of immunosuppressive medications in IBD.

Introduction

Crohn's disease and ulcerative colitis are chronic relapsing idiopathic conditions of the gastrointestinal tract that generally begin in early adulthood. The overall prevalence of inflammatory bowel disease (IBD) is approximately 0.4% in Europeans and North Americans.[1] Patients with IBD are at an increased baseline risk for intestinal and extraintestinal cancers[2] compared with the background population, and this increased risk is mostly attributed to chronic inflammation and immune dysregulation. Over the last 2 decades, the treatment of IBD patients has changed drastically, with increasing use of immunomodulators, antitumor necrosis factor agents, and anti-integrin therapy. Certain immunosuppressive medications may be potentially carcinogenic by reducing immune surveillance, directly altering cell DNA,[3] and impairing immune control by mutagenic viruses.[4] The focus of this review is to assess the temporal trends in the risk of cancer in IBD patients in a setting of increasing use of immunosuppressive medications and better surveillance techniques for neoplastic diseases.

processing....