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IBD-associated colorectal cancers were found to occur in younger patients and have worse outcomes. Researchers call for urgent improvement of early detection methods to provide more risk-based and personalised care.

Inflammatory bowel diseases (IBDs) are associated with an increased risk of developing colorectal (bowel) cancer (CRC). 

Published last month in the American Journal of Gastroenterology, research co-authored by Professor Eva Morris (Nuffield Department of Population Health) reveals key differences between patients with CRC and those with IBD-related CRC (IBD-CRC).

In what is believed to be the largest such study to date, the research draws on population data from the NHS to compare the symptoms and outcomes of all 390,614 UK cases of CRC with and without a prior diagnosis of IBD between 2005 and 2018.

Of the patients diagnosed with CRC over the study period, 1.3% had IBD-CRC. On average, these cases were younger than the CRC cases (median age at CRC diagnosis was 66 years for those with IBD, vs 72 years for those without) and more likely to be diagnosed as an emergency (25.1% of IBD-CRC patients were diagnosed as an emergency vs 16.7% of CRC patients without IBD). The overall rate of new tumours developing after diagnosis was also higher in those with IBD.

A lower proportion of those with IBD-CRC survived to two years from diagnosis than those without IBD. There was no significant difference between those with stage I CRC and those with stage I IBD-CRC, however those with IBD-CRC in stage II to stage IV of the disease had significantly worse survival rates than those without.

The authors argue that there is an urgent need to understand these differences to guide screening, surveillance, and treatment strategies for patients with IBD-CRC. Commenting on the findings, Professor Morris said:

 ‘Our research shows that outcomes for patients with IBD-related CRC are, unfortunately, worse than patients without IBD. We urgently need to improve early detection methods for those with IBD-related CRC - and better define patients at the greatest risk of adverse outcomes - to provide more risk-based and personalised care.’ 

Nick Burr, consultant Gastroenterologist and visiting researcher at Oxford University, and one of the lead authors on the paper, added:

‘It is important to stress that the overall risk of bowel cancer occurring in IBD patients is low, but highlighting the differences between CRC patients with IBD and those without is still important. It will help in planning appropriate and timely investigations, and will hopefully stimulate further research into whether specialised treatments are needed for this group.’ 

Read the full article in The American Journal of Gastroenterology