Screening and surveillance of ulcerative colitis

There is an increased risk of colorectal cancer in patients who have had an attack of chronic ulcerative colitis, and there is evidence to suggest that patients with Crohn's disease are also at risk. It is difficult to give a precise estimate of the increased danger that patients with inflammatory bowel disease have over the normal population because published results are inconsistent. Twenty years ago patients with long-standing extensive ulcerative colitis were often advised to undergo proctocolectomy to protect against the development of cancer, but since then most physicians have adopted a policy of regular colonoscopic surveillance in an attempt to detect early cancer or pre-cancer. When published studies of surveillance results are critically analyzed, it appears that relatively little benefit accrues from this approach. Better methods of surveillance are needed to determine which individuals with chronic ulcerative colitis are most likely to develop cancer.