No long-term rise in colon cancer for ulcerative colitis patients

Apr 30, 2006

NEW YORK (Reuters Health), May 1 - The incidence of colorectal cancer (CRC) remains constant in ulcerative colitis (UC) patients up to 40 years of disease duration, a new study from the U.K. shows.

The 30-year follow-up study, published in the April issue of Gastroenterology, also found that intensive colonoscopic surveillance was beneficial for two-thirds of the patients who developed potentially life-threatening neoplasia during the course of the study.

Dr. Matthew D. Rutter and colleagues at St. Mark's Hospital in London reviewed the records of 600 patients followed for a total of 5,932 patient years. In the hospital's program, patients are offered one or two colonoscopies per year eight years after UC symptoms first appear.

Seventy-four patients (12.3%) developed neoplasia during the course of the study, 30 of whom had CRC. The researchers believe that 16 were "interval cancers," lesions that developed between scheduled surveillance exams or after a missed scheduled exam.

The cumulative incidence of CRC was 2.5% after 20 years disease duration, 7.6% after 30 years, and 10.8% after 40 years, which was lower than reported by most other studies, the researchers note. CRC incidence decreased over time. Seventy-three percent of patients who developed CRC survived for five years after surgery.

On average, clinicians at the hospital performed eight biopsies per colonoscopy or one for each colon segment. Dr. Rutter's team concludes that surveillance can be effective. "However, we believe that there is a clear need to improve the efficacy of surveillance further, both by better patient selection, and by improved surveillance techniques such as pancolonic dye spraying."

In an editorial accompanying the study, Dr. David T. Rubin of the University of Chicago notes that ensuring endoscopists and pathologists accurately identify dysplasia has been "a major challenge" in CRC prevention among inflammatory bowel disease patients, with the management of low-grade dysplasia being particularly controversial.

Increasing the number of biopsies from eight per colonoscopy may have improved the rate of cancer detection, Dr. Rubin notes. "Even though the median number of biopsies per case was lower than that which is recommended," he adds, "the findings of concurrent and subsequent cancers in this study strongly support a practice of referral to colectomy when low-grade dysplasia is identified and confirmed."

Last Updated: 2006-04-28 16:29:07 -0400 (Reuters Health)

Gastroenterology 2006;130:1030-1038,1350-1352.

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