Cancer surveillance should be implemented in pediatric inflammatory bowel disease (pIBD), as these patients have been found to be at an increased risk for cancer and mortality, according to research presented in Alimentary Pharmacology and Therapeutics.
Researchers conducted a registry study of all patients age <18 years diagnosed with pIBD in Denmark and Finland. The cohort was cross-linked to the national cancer registries and the national cause of death registries that identified patients who developed cancer and/or died after being diagnosed with pIBD. Patients were categorized by a diagnosis of Crohn disease (CD), ulcerative colitis (UC), or IBD-unclassified.
A total of 6689 patients (3333 from Denmark and 3357 from Finland) were included in the study. The mean age at diagnosis was 14.0 years, and mean follow-up time was 9.6 years. In the combined pIBD cohort, 720 patients underwent a total colectomy performed in a median time frame from diagnosis to colectomy of 2.8 years. A total of 1365 patients underwent bowel resections during follow-up.
A total of 72 cases of cancer (38 in Denmark and 34 in Finland) were observed in the pIBD cohort, with an incidence rate of 10 per 10,000 person-years. Median age at cancer diagnosis was 25 years. In CD, the overall cancer incidence was 10.7 per 10,000 person-years, with a median time from diagnosis of pIBD to cancer of 11.2 years. For patients with UC, the overall cancer incidence was 9.7 per 10,000 person-years, with a median time from diagnosis of pIBD to cancer of 11.5 years.
Of the patients with pIBD, 65 died (29 in Denmark and 36 in Finland). The incidence rate of mortality was 9.1/10,000 person-years, with a median time from diagnosis of pIBD to mortality of 9.4 years. The mean age at death was 22.0 years; leading causes of mortality included cancer (1 in 4008 patient-years), suicide (1 in 4509 patient-years), and infections (1 in 6558 patient-years). Of the patients with infections, half had a sepsis diagnosis as the primary cause of death; the remaining died from pneumonia and meningococcal meningitis.
“In conclusion, we found an increased risk of both cancer and mortality in pIBD with cancer presentation from the late teens and early adulthood,” the authors concluded. “This adds to the mounting evidence that pIBD is a distinct IBD phenotype and should be appreciated as a disease modifier predicting a more aggressive disease course compared to adult onset IBD.”
Malham M, Jakobsen C, Paerregaard A, Virta LJ, Kolho KL, Wewer V. The incidence of cancer and mortality in paediatric onset inflammatory bowel disease in Denmark and Finland during a 23-year period: a population-based study [published online May 8, 2019]. Aliment Pharmacol Ther. doi:10.1111/apt.15258