Dr Long spoke at the Crohn's & Colitis Congress 2023 in Denver, Colorado, on the risks of malignancy associated with inflammatory bowel disease and how to discuss absolute risks with patients when choosing therapy.

Millie Long, MD, is a professor of medicine at the University of North Carolina and vice chief of Education and director of the fellowship program in the Division of Gastroenterology and Hepatology.

TRANSCRIPT:

Hello, my name is Millie Long. I'm from University of North Carolina in Chapel Hill, and I'm here at the Crohn's & Colitis Congress 2023 in Denver, Colorado. And we just had a session where I discussed malignancy risk and inflammatory bowel disease. I wanted to share a few of the pearls from the session. First off, when we look over time in population-based studies, one of the concerns as we've come into the biologic era is, are we potentially causing increased malignancies associated with these therapies? And thankfully, the answer to that is no. In fact, over time, as we're more effectively treating bowel inflammation, we're seeing reductions in the risk of colorectal malignancy and no increased risk of extraintestinal malignancies. And so I think these are very reassuring data for our patients.

We also now have a number of mechanisms of action, and I think that we just need to understand what the signals are with each of these. And one of the most important aspects is our novel biologics, our IL-12/23s, IL-23s, and anti-integrins, we've not seen any sort of increased malignancy risk. We do have a slight increased absolute risk of lymphoma in patients on thiopurines and the same is true of TNFs. But when the 2 are used together, a slightly higher absolute risk, about 6 for 10,000, of developing lymphoma in combination therapy with a thiopurine and an anti-TNF. But importantly from data from the French CESAME cohort, it shows that once you stop that thiopurine, that risk actually returns to normal. So you're not continuing to accrue risk.

One of the other major risks we see is actually that of skin cancer, both nonmelanoma and melanoma skin cancer. What can be important about this particular type of malignancy is it is truly driven by photosensitivity. Mechanistically we know, for example, that thiopurines selectively increase sensitivity to ultraviolet A light. And those sunburns are what increases the risk over time of developing skin cancer. So if we can appropriately prevent this by counseling on broad spectrum sunscreen use and having dermatologic screening exams, we really can improve those outcomes for our patients.

Why this is so important is because these therapies can be effective and they can minimize other risks, other complications of disease, the requirement for surgery, even the downstream effects of long-term inflammation, such as colorectal cancer malignancies. And so when you weigh this risk and benefit, and you do so by talking to patients using absolute numbers, the numbers that they can understand out of a common denominator like 10,000, this really helps the patient to frame the risks and benefits and recognize that these therapies are associated with benefits over the long term in terms of treatment of their disease.

So I hope these pearls have helped you to kind of better discuss malignancy risk with your patients and recognize the rare absolute risk-mitigating factors and how we can improve the lives of our patients by effectively treating their disease and potentially preventing some of these malignancy complications through preventive efforts.