ABSTRACT: BACKGROUND & AIMS: Data regarding the risk of gastrointestinal and extra-intestinal cancers in Crohn's disease (CD) and ulcerative colitis (UC) are needed to understand the clinical course of inflammatory bowel diseases (IBDs) and their treatments. METHODS: We performed a nationwide historical cohort study using Danish healthcare databases. We identified patients with a diagnosis of CD or UC, recorded from 1978 through 2010, and followed them until first occurrence of cancer, death, or emigration. We used standardized incidence ratios (SIRs) to compare cancer incidence in CD and UC patients to that expected in the general population. RESULTS: Excluding cancers diagnosed within 1 year of IBD diagnosis, 772 cases of invasive cancer occurred among 13,756 patients with CD (SIR, 1.3; 95% confidence interval [CI], 1.2-1.4) and 2331 occurred among 35,152 patients with UC (SIR, 1.1; 95% CI, 1.0-1.1). CD was weakly associated with gastrointestinal cancers (SIR 1.2; 95% CI, 1.0-1.4) and extra-intestinal cancers (SIR, 1.3; 95% CI, 1.2-1.4), with the strongest associations for hematological malignancies (SIR, 1.9; 95% CI, 1.5-2.3), smoking-related cancers (SIR 1.5, 95% CI 1.3-1.8), and melanoma (SIR, 1.4; 95% CI, 1.0-1.9). Associations between UC and gastrointestinal and extra-intestinal cancers were weaker (SIR, 1.1; 95% CI, 1.0-1.2 and SIR, 1.1; 95% CI, 1.0-1.1, respectively). The relative risk of extra-intestinal cancers among patients with IBD was relatively stable over time, although the risk of gastrointestinal cancers decreased. CONCLUSIONS: Patients with IBD, particularly CD, are at increased risk for gastrointestinal and extra-intestinal malignancies. The relative risk of gastrointestinal malignancy has deceased since 1978, without a concomitant increase in the risk of non-gastrointestinal malignancy.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2013; · 5.64 Impact Factor
ABSTRACT: Gastroesophageal reflux disease is a strong risk factor for esophageal adenocarcinoma, but it is not clear whether the mucosal inflammation that develops in patients with reflux disease promotes this cancer. We determined the development of adenocarcinoma among patients who underwent esophagogastroduodenoscopy and were found to have erosive (with esophagitis) or nonerosive (without esophagitis) reflux.
We performed a nationwide cohort study using data from 33,849 patients with reflux disease (52% men; median age, 59.3 y) from population-based Danish medical registries, from 1996 through 2008. The observed incidences of adenocarcinoma were compared with the expected incidence for the general population, standardized by age, sex, and calendar time. Absolute risks were estimated using Kaplan-Meier methods.
In the study cohort, 26,194 of the patients (77%) had erosive reflux disease and 37 subsequently developed esophageal adenocarcinoma after a mean follow-up time of 7.4 years. Their absolute risk after 10 years was 0.24% (95% confidence interval [CI], 0.15%-0.32%). The incidence of cancer among patients with erosive reflux disease was significantly greater than that expected for the general population (standardized incidence ratio, 2.2; 95% CI, 1.6-3.0). In contrast, of the 7655 patients with nonerosive reflux disease, only 1 was diagnosed with esophageal adenocarcinoma after 4.5 years of follow-up evaluation (standardized incidence ratio, 0.3; 95% CI, 0.01-1.5).
Erosive reflux disease, but not nonerosive disease, increased the risk of esophageal adenocarcinoma, based on analysis of population-based Danish medical registries. Inflammation therefore might be an important factor in the progression from reflux to esophageal adenocarcinoma.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 01/2012; 10(5):475-80.e1. · 5.64 Impact Factor
ABSTRACT: In contrast to deep venous thrombosis and pulmonary embolism, superficial venous thrombosis has not been considered to be a marker of occult cancer. However, actual data regarding the association are very limited.
We identified all patients in Denmark from 1994 to 2009 with a diagnosis of superficial venous thrombosis, deep venous thrombosis in the legs or pulmonary embolism using population-based health registries. The occurrence of cancer in the three venous thromboembolism cohorts was compared with the expected numbers of cases estimated using national incidence rates to compute standardised incidence ratios (SIRs).
We identified a total of 7663 patients with superficial venous thrombosis, 45,252 with deep venous thrombosis and 24,332 with pulmonary embolism. In the first year of follow-up, very similar proportions of patients in the three cohorts were diagnosed with cancer. The SIR was 2.46 (95% CI, 2.10-2.86) for superficial venous thrombosis, 2.75 (95% CI, 2.60-2.90) for deep venous thrombosis, and 3.27 (95% CI, 3.03-3.52) for pulmonary embolism. After one year, the SIRs declined to 1.05 (95% CI, 0.96-1.16), 1.11 (95% CI 1.07-1.16) and 1.15 (95% CI, 1.09-1.22), respectively. For all three patient cohorts, particularly strong associations were found for cancers of the liver, lung, ovaries and pancreas as well as for non-Hodgkin's lymphoma.
Venous thrombosis, whenever it is seen in the lower limbs, is a preclinical marker of prevalent cancer, particularly during the first year after diagnosis.
European journal of cancer (Oxford, England: 1990) 11/2011; 48(4):586-93. · 4.12 Impact Factor