Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases


Ananthakrishnan AN, Cagan A, Cai T, Gainer VS, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, Liao KP. Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2015;13 :322-329 e1.

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BACKGROUND & AIMS: Crohn's disease and ulcerative colitis are associated with an increased risk of colorectal cancer (CRC). Surveillance colonoscopy is recommended at 2- to 3-year intervals beginning 8 years after diagnosis of inflammatory bowel disease (IBD). However, there have been no reports of whether colonoscopy examination reduces the risk for CRC in patients with IBD. METHODS: In a retrospective study, we analyzed data from 6823 patients with IBD (2764 with a recent colonoscopy, 4059 without a recent colonoscopy) seen and followed up for at least 3 years at 2 tertiary referral hospitals in Boston, Massachusetts. The primary outcome was diagnosis of CRC. We examined the proportion of patients undergoing a colonoscopy within 36 months before a diagnosis of CRC or at the end of the follow-up period, excluding colonoscopies performed within 6 months before a diagnosis of CRC, to avoid inclusion of prevalent cancers. Multivariate logistic regression was performed, adjusting for plausible confounders. RESULTS: A total of 154 patients developed CRC. The incidence of CRC among patients without a recent colonoscopy (2.7%) was significantly higher than among patients with a recent colonoscopy (1.6%) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39-0.80). This difference persisted in multivariate analysis (OR, 0.65; 95% CI, 0.45-0.93) and was robust when adjusted for a range of assumptions in sensitivity analyses. Among patients with CRC, a colonoscopy within 6 to 36 months before diagnosis was associated with a reduced mortality rate (OR, 0.34; 95% CI, 0.12-0.95). CONCLUSIONS: Recent colonoscopy (within 36 months) is associated with a reduced incidence of CRC in patients with IBD, and lower mortality rates in those diagnosed with CRC.


Ananthakrishnan, Ashwin NCagan, AndrewCai, TianxiGainer, Vivian SShaw, Stanley YChurchill, SusanneKarlson, Elizabeth WMurphy, Shawn NKohane, IsaacLiao, Katherine PengK08 AR060257/AR/NIAMS NIH HHS/K23 DK097142/DK/NIDDK NIH HHS/K24 AR052403/AR/NIAMS NIH HHS/P30 DK043351/DK/NIDDK NIH HHS/P60AR047782/AR/NIAMS NIH HHS/R01 AR049880/AR/NIAMS NIH HHS/U54 LM008748/LM/NLM NIH HHS/U54-LM008748/LM/NLM NIH HHS/Research Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov't2014/07/22 06:00Clin Gastroenterol Hepatol. 2015 Feb;13(2):322-329.e1. doi: 10.1016/j.cgh.2014.07.018. Epub 2014 Jul 17.