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IBD Guidelines Fall Short on CRC Prevention
Researchers recently reviewed professional society guidelines for prevention of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD), and concluded that most lack high-quality evidence to support their recommendations and fail to address important steps in cancer prevention.
In September 2020, the investigators performed a systematic search of several databases to identify all professional guidelines related to preventing CRC among patients with Crohn disease or ulcerative colitis. They reviewed the recommendations for conflicts of interest (COIs) and funding; the quality and strength of recommendations; whether these guidelines were subject to external review, and other factors, as set forth in the standards of the Institute of Medicine standards. The researchers also compared recommendations to each other.
Of 149 recommendations from 14 different societies and guidelines, some failed to provide recommendations on key elements of screening initiation and surveillance; screening modality; pharmacological chemoprevention; dysplasia management and follow-up; and the use of molecular markers.
“Only 71% of guidelines disclosed COIs, 43% reported industry funding, 14% were externally reviewed, 7% included patient representation, and 36% had plans for update,” the investigators reported. “Of the total recommendations, 7.4%, 23.5%, and 69.1% were based on high,- moderate-, and low-quality evidence, respectively.”
The review further revealed that of all the recommendations, 20.1% were strong, 14.1% were weak or conditional, and 65.8% were not assigned a strength.
“Many guidelines do not provide recommendations on key aspects of CRC prevention in IBD,” the investigators wrote. “Over 90% of recommendations are based on low- to moderate-quality evidence; therefore, further studies on CRC prevention in IBD are needed to improve the overall quality of evidence.”
—Rebecca Mashaw
Reference:
Weissman S, Systrom HK, Aziz M, et al. Colorectal cancer prevention in inflammatory bowel disease: a systematic snalysis of the overall Quality of guideline recommendations. Inflamm Bowel Dis. izab164. https://doi.org/10.1093/ibd/izab164
