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DOP097. Decreased colorectal cancer risk in Dutch ulcerative colitis patients: results from the population based IBD-SL cohort

T. van den Heuvel1,2, S. Jeuring1,2, M. Wassink2, C. Glorie2, L. Oostenbrug3, M. Romberg-Camps4, W. Hameeteman2, A. Masclee1,2, D. Jonkers1,2, M. Pierik1,2, 1Maastricht University Medical Center+, NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht, Netherlands, 2Maastricht University Medical Center+, Internal Medicine - Division Gastroenterology-Hepatology, Maastricht, Netherlands, 3Atrium Medical Center, Internal Medicine and Gastroenterology, Heerlen, Netherlands, 4Orbis Medical Centre, Gastroenterology and Hepatology, Sittard-Geleen, Netherlands

Background

Although many studies found an increased colorectal cancer (CRC) risk in ulcerative colitis (UC), this increase is less pronounced or absent in recent literature. A nationwide Danish study even demonstrates a protective effect in the last decade, possibly due to changes in IBD management. It is unclear whether risk estimates of extra-intestinal cancers (EIC) have also changed in the last decade. Here, we aim to confirm the protective effect in CRC, and to assess the risk of EICs in a Dutch population based cohort (IBD-SL). As use of immunomodulators and anti-TNF rises, we also assess the risk of immunosuppression-related cancers (IRC).

Methods

All IBD-SL patients diagnosed with UC between 1991 and 2011 were followed until 2012. Observed primary cancers were determined by scrutinizing all hospital records and the Dutch Pathology Database. Local incidence rates of cancers were derived from the Dutch Cancer Registry. Age- and sex-adjusted Standardized Cancer Incidence Ratio (SIR) were calculated for overall cancer, CRC, common EICs (i.e. breast, prostate and overall skin cancer) and IRCs (i.e. basal-cell carcinoma, melanoma and lymphoma). Confidence intervals were determined by Byar's approximation.

Results

In total, 1595 UC patients (54% male) were diagnosed between 1991 and 2011. Mean age at diagnosis and mean disease duration were 46.5 (SD 16.3) and 9.4 years (SD 5.9), respectively. Observed cancers, expected cancers, SIRs and confidence intervals are shown in the table. The overall cancer risk in UC patients was similar to the normal population, but the risk was decreased for CRC (SIR 0.45, 0.95% 0.19–0.88). Furthermore, the risk for prostate cancer and overall skin cancer did not differ, whereas the risk for breast cancer was decreased (SIR 0.28, 0.95% CI 0.14–0.51). The risk for IRCs (basal-cell carcinoma, melanoma and lymphoma) did not differ from the normal population.

Table: Standardized incidence ratios of 1595 UC patients from the population based IBD-SL cohort
 OESIR95% CI
Overall 146 164.45 0.89 0.75–1.04
CRC 8 17.82 0.45 0.19–0.88
EIC
 Skin (overall) 59 51.77 1.14 0.87–1.47
 Prostate 20 16.34 1.22 0.75–1.89
 Breast 11 38.72 0.28 0.14–0.51
IRC
 BCC 47 38.59 1.22 0.89–1.62
 Melanoma 4 4.57 0.87 0.24–2.24
 Lymphoma 7 5.04 1.39 0.56–2.86
O, number of observed cancers; E, number of expected cancers; SIR, standardized incidence ratio; CRC, colorectal cancer; EIC, extra-intestinal cancer; IRC, immunosuppressant-related cancer; BCC, basal-cell carcinoma.

Conclusion

We confirmed a decreased CRC risk in the UC patients of our population based IBD-SL cohort. We could not find an increased risk of IRC, despite frequent use of immunosuppressants (33%) in our cohort. Furthermore, no differences were found for overall cancer, prostate cancer and skin cancer risk, as compared to the normal population, whereas risk for breast cancer was clearly decreased. This may in part be explained by a decreased prevalence of lifestyle risk factors.