Colorectal Cancer Risk Still Up in Patients With Ulcerative Colitis

Patients with ulcerative colitis have an increased risk for colorectal cancer and colorectal cancer mortality, according to a study published in the January issue of The Lancet.

Ola Olén, M.D., from the Karolinska Institutet in Stockholm, and colleagues compared overall and country-specific risks for colorectal cancer mortality and incident colorectal cancer among 96,447 patients with ulcerative colitis in Denmark and Sweden. Patients were compared with 949,207 matched reference individuals from the general population and were followed from Jan. 1, 1969, to Dec. 31, 2017.

The researchers identified 1,336 incident colorectal cancers in the ulcerative colitis cohort and 9,544 incident colorectal cancers in reference individuals (1.29 versus 0.82 per 1,000 person-years; hazard ratio, 1.66). Overall, 639 and 4,451 patients died from colorectal cancer in the ulcerative colitis and reference cohorts, respectively (0.55 versus 0.38 per 1,000 person-years; hazard ratio, 1.59). Among individuals with ulcerative colitis, the colorectal cancer stage distribution was less advanced than in matched reference individuals. However, after accounting for tumor stage, patients with ulcerative colitis still had an increased risk for cancer mortality (hazard ratio, 1.54). Over calendar periods, the excess risks declined, with a hazard ratio for incident colorectal cancer of 1.38 during 2013 to 2017 (Sweden only) and a hazard ratio for colorectal cancer mortality of 1.25.

"Despite current extensive endoscopy screening in both Denmark and Sweden, patients with ulcerative colitis still had excess colorectal cancer mortality when taking tumor stage into account, indicating that there may still be room for improvement in current surveillance programs," the authors write.

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