Associations of Inflammatory Bowel Disease and Subsequent Cancers in a Population-Based Study of Older Adults in the United States

Overview

Journal JNCI Cancer Spectr

Publisher Oxford University Press

Specialty Oncology

Date 2022 Jan 24

PMID 35071980

Authors

Jeanny H Wang

Monica DArcy

Edward L Barnes

Neal D Freedman

Eric A Engels

Minkyo Song

Affiliations

Soon will be listed here.

Abstract

Background: Cancer risk is elevated in patients with inflammatory bowel disease (IBD). A comprehensive investigation of cancer risk in older patients (≥66 years of age) is needed, because this understudied population is at high risk.

Methods: We performed a case-control study using Surveillance Epidemiology and End Results-Medicare data including 1 986 735 incident cancer cases (aged 66-99 years; diagnosed 1992-2015) and 200 000 controls matched by sex, age, race and ethnicity, and selection year. IBD was identified by ulcerative colitis (UC) or Crohn's disease (CD) diagnosis codes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for potential confounders. For colorectal cancers, we further adjusted for screening rates. We assessed confounding by medication exposure among patients with prescription drug coverage.

Results: IBD, CD, and UC were present in 0.8%, 0.3%, and 0.5% in both cancer cases and non-cancer controls. Of 51 cancers examined, IBD was statistically significantly associated with cancers of the small intestine (OR = 2.55, 95% CI = 2.15 to 3.01), intrahepatic (OR = 1.92, 95% CI = 1.47 to 2.51) and extrahepatic bile ducts (OR = 1.75, 95% CI = 1.38 to 2.22), rectum (OR = 1.61, 95% CI = 1.36 to 1.90), and colon (OR = 1.21, 95% CI = 1.10 to 1.33). CD was associated with cancers of the small intestine (OR = 4.55, 95% CI = 3.65 to 5.67), and UC was associated with cancers of the intrahepatic bile ducts (OR = 1.87, 95% CI = 1.34 to 2.61), rectum (OR = 1.80, 95% CI = 1.47 to 2.20), and colon (OR = 1.28, 95% CI = 1.14 to 1.43). After adjusting for medication exposure, IBD was not statistically significantly associated with lung cancer, melanoma, diffuse large B-cell lymphoma, and myelodysplastic syndrome.

Conclusions: In this large study among older adults (≥66 years of age), IBD was positively associated with gastrointestinal cancers. Associations with extraintestinal cancers may reflect the effect of immunosuppressive medications.

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References

Cheddani H, Dauchet L, Fumery M, Charpentier C, Bouvier A, Dupas J . Cancer in Elderly Onset Inflammatory Bowel Disease: A Population-Based Study. Am J Gastroenterol. 2016; 111(10):1428-1436. DOI: 10.1038/ajg.2016.304. View

Ungaro R, Mehandru S, Allen P, Peyrin-Biroulet L, Colombel J . Ulcerative colitis. Lancet. 2016; 389(10080):1756-1770. PMC: 6487890. DOI: 10.1016/S0140-6736(16)32126-2. View

Doria-Rose V, Kamineni A, Barrett M, Ko C, Weiss N . Case-Control Studies of the Efficacy of Screening Tests That Seek to Prevent Cancer Incidence: Results of an Approach That Utilizes Administrative Claims Data That Do Not Provide Information Regarding Test Indication. Am J Epidemiol. 2019; 188(4):703-708. PMC: 6438806. DOI: 10.1093/aje/kwy274. View

Pietersma F, Piriou E, van Baarle D . Immune surveillance of EBV-infected B cells and the development of non-Hodgkin lymphomas in immunocompromised patients. Leuk Lymphoma. 2008; 49(6):1028-41. DOI: 10.1080/10428190801911662. View

Liu L, Allison J, Herrinton L . Validity of computerized diagnoses, procedures, and drugs for inflammatory bowel disease in a northern California managed care organization. Pharmacoepidemiol Drug Saf. 2009; 18(11):1086-93. DOI: 10.1002/pds.1824. View

Ananthakrishnan A, Shi H, Tang W, Law C, Sung J, Chan F . Systematic Review and Meta-analysis: Phenotype and Clinical Outcomes of Older-onset Inflammatory Bowel Disease. J Crohns Colitis. 2016; 10(10):1224-36. PMC: 6082591. DOI: 10.1093/ecco-jcc/jjw054. View

Barnes E, Jiang Y, Kappelman M, Long M, Sandler R, Kinlaw A . Decreasing Colectomy Rate for Ulcerative Colitis in the United States Between 2007 and 2016: A Time Trend Analysis. Inflamm Bowel Dis. 2019; 26(8):1225-1231. PMC: 7365804. DOI: 10.1093/ibd/izz247. View

Zheng H, Jiang X . Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease: a meta-analysis of 16 observational studies. Eur J Gastroenterol Hepatol. 2016; 28(4):383-90. DOI: 10.1097/MEG.0000000000000576. View

Castano-Milla C, Chaparro M, Gisbert J . Systematic review with meta-analysis: the declining risk of colorectal cancer in ulcerative colitis. Aliment Pharmacol Ther. 2014; 39(7):645-59. DOI: 10.1111/apt.12651. View

10.

Everhov A, Halfvarson J, Myrelid P, Sachs M, Nordenvall C, Soderling J . Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden. Gastroenterology. 2017; 154(3):518-528.e15. DOI: 10.1053/j.gastro.2017.10.034. View

11.

Beaugerie L, Svrcek M, Seksik P, Bouvier A, Simon T, Allez M . Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease. Gastroenterology. 2013; 145(1):166-175.e8. DOI: 10.1053/j.gastro.2013.03.044. View

12.

Mertz A, Nguyen N, Katsanos K, Kwok R . Primary sclerosing cholangitis and inflammatory bowel disease comorbidity: an update of the evidence. Ann Gastroenterol. 2019; 32(2):124-133. PMC: 6394256. DOI: 10.20524/aog.2019.0344. View

13.

Khan N, Vallarino C, Lissoos T, Darr U, Luo M . Risk of Malignancy in a Nationwide Cohort of Elderly Inflammatory Bowel Disease Patients. Drugs Aging. 2017; 34(11):859-868. PMC: 5705754. DOI: 10.1007/s40266-017-0498-y. View

14.

Trivedi P, Crothers H, Mytton J, Bosch S, Iqbal T, Ferguson J . Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology. 2020; 159(3):915-928. DOI: 10.1053/j.gastro.2020.05.049. View

15.

Kochar B, Jiang Y, Winn A, Barnes E, Martin C, Long M . The Early Experience With Vedolizumab in the United States. Crohns Colitis 360. 2019; 1(3):otz027. PMC: 6798787. DOI: 10.1093/crocol/otz027. View

16.

. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008; 149(9):627-37. DOI: 10.7326/0003-4819-149-9-200811040-00243. View

17.

Kappelman M, Farkas D, Long M, Erichsen R, Sandler R, Sorensen H . Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol. 2013; 12(2):265-73.e1. PMC: 4361949. DOI: 10.1016/j.cgh.2013.03.034. View

18.

Velayos F, Loftus Jr E, Jess T, Harmsen W, Bida J, Zinsmeister A . Predictive and protective factors associated with colorectal cancer in ulcerative colitis: A case-control study. Gastroenterology. 2006; 130(7):1941-9. DOI: 10.1053/j.gastro.2006.03.028. View

19.

Hemminki K, Li X, Sundquist J, Sundquist K . Cancer risks in Crohn disease patients. Ann Oncol. 2008; 20(3):574-80. DOI: 10.1093/annonc/mdn595. View

20.

Ko C, Doria-Rose V, Barrett M, Kamineni A, Enewold L, Weiss N . Screening colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence: A case-control study. PLoS One. 2019; 14(12):e0226027. PMC: 6894764. DOI: 10.1371/journal.pone.0226027. View