Colorectal Cancer-Related Death Remains High Among Patients With UC

Despite recent advances in surveillance and treatment, individuals with ulcerative colitis (UC) are still at greater risk of developing and dying from colorectal cancer (CRC) than those without UC, according to new research.¹

“The risk of colorectal cancer has dropped substantially over the past 30 years, but in spite of this patients who have had access to modern treatments for ulcerative colitis and screening for colorectal cancer still have a significantly elevated risk,” Ola Olén, MD, a senior researcher in the Department of Medicine in Solna at the Karolinska Institutet in Sweden, and first author of the study, said in a press release.”²

To reach this conclusion, the researchers assessed for CRC mortality and incident CRC between January 1, 1969, and December 31, 2017, among 32,919 patients with UC from Denmark and 63,528 patients with UC from Sweden.

The mortality and incidence rates were compared with those of 949,207 individuals without UC from the general populations of both countries. These individuals were matched with the UC group patients for sex, age, birth year, and place of residence.

Incident CRC was higher in the UC group than among the group without UC. While the former had 1336 incident CRCs (1.29 per 1000 person-years), the latter had 9544 incident CRCs (0.82 per 1000 person-years).¹ In turn, the chances of a patient with CRC receiving a diagnosis of UC was 66% percent higher than in the control group.²

CRC-related mortality was also higher in the UC group. In all, 639 patients with UC died from CRC (0.55 per 1000 person-years), and 4451 patients without UC died from CRC (0.38 per 1000 person-years).¹ In turn, the mortality rate was 59% higher in the UC group than in the general population.²

And although the individuals with UC were more likely to receive a diagnosis of less advanced CRC than those without UC, patients with UC still had an increased risk of CRC-caused mortality.

“An important result of the study is that the risks are indeed elevated but there are major differences from one patient group to another,” Dr Olén said.

After following up with the Swedish patients from 2013 to 2017, the researchers found that the UC group had a 38% higher chance of a CRC diagnosis and a 25% higher chance of CRC-mortality than the general population.²

“There still seems to be room for improvement in international surveillance guidelines,” the researchers concluded.¹

—Colleen Murphy

References:

1. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet. 2020;395(10218):123-131. doi:10.1016/S0140-6736(19)32545-0.

2. Colorectal cancer risk remains despite modern treatment for ulcerative colitis [press release]. Stockholm, Sweden: Karolinska Institutet; January 10, 2020. https://news.ki.se/colorectal-cancer-risk-remains-despite-modern-treatment-for-ulcerative-colitis?_ga=2.242845826.1243366297.1578673182-463277043.1578673182. Accessed January 10, 2020.