Colorectal Cancer in Childhood-onset Inflammatory Bowel Disease: A Scandinavian Register-based Cohort Study, 1969-2017
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Åsa H Everhov1,2, Jonas F Ludvigsson3,4,5, Jacob Järås2
1From the Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Insights
Children diagnosed with Crohn disease (CD) or ulcerative colitis (UC) face a significantly higher risk of developing colorectal cancer (CRC). This risk increases with earlier disease onset, highlighting the need for age-specific surveillance strategies.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Childhood-onset inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), affects a substantial pediatric population.
- Long-term outcomes and cancer risks associated with early-onset IBD require further investigation for effective patient management.
- Understanding the specific risks of colorectal cancer (CRC) in these young patients is crucial for developing targeted surveillance programs.
Purpose of the Study:
- To investigate the association between childhood-onset inflammatory bowel disease (IBD) and the subsequent risk of developing colorectal cancer (CRC).
- To compare CRC incidence in patients with childhood-onset Crohn disease (CD) and ulcerative colitis (UC) against matched reference individuals.
- To evaluate how age at diagnosis and disease phenotype influence CRC risk in pediatric IBD patients.
Main Methods:
- Utilized linkage of Danish and Swedish national register data to identify 6937 patients with childhood-onset CD and 8514 with childhood-onset UC.
- Matched each patient with up to 10 reference individuals based on sex, age, and residence for comparison.
- Conducted a longitudinal follow-up study from 1969 to 2017, analyzing CRC diagnoses and calculating hazard ratios (HR).
Main Results:
- A significantly elevated hazard ratio (HR) for CRC was observed in childhood-onset CD (HR=6.46) and UC (HR=32.5) compared to reference individuals.
- CRC risk increased with decreasing age at diagnosis for both CD and UC patients.
- All IBD phenotypes showed an increased CRC risk, with higher estimates for colonic CD and extensive/pancolitis in UC.
Conclusions:
- Childhood-onset inflammatory bowel disease (IBD) confers a substantially increased relative risk of colorectal cancer (CRC).
- The risk of CRC is influenced by age at diagnosis, with earlier onset associated with higher risk.
- Age at onset should be considered a critical factor in the implementation of surveillance programs for pediatric IBD patients.
Abstract:
Through linkage of data from Danish and Swedish national registers we identified 6937 patients with childhood (<18 years)-onset Crohn disease (CD), 8514 patients with childhood-onset ulcerative colitis (UC) and up to 10 times as many matched (sex, age, residence) reference individuals 1969-2017. During follow-up to a median age of 27 (interquartile range = 21-39) years, 25 (0.36%) CD patients were diagnosed with colorectal cancer (CRC) versus 43 (0.06%) reference individuals, and 113 (1.33%) UC patients versus 45 (0.05%) reference individuals. The hazard ratio (HR) for CRC was 6.46 (95% CI = 3.95-10.6) in CD and 32.5 (95% CI = 23.0-45.9) in UC and increased with decreasing age at diagnosis. The HR for CRC was increased for all phenotypes, but with higher estimates for colonic CD [17.9 (95% CI = 7.43-43.3)] and UC with extensive/pancolitis [36.3 (95% CI = 22.8-57.8)]. The relative risk of CRC was increased for all phenotypes of childhood-onset inflammatory bowel disease. Age at onset may be considered an additional risk factor when implementing surveillance programs.
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