Inflammatory Bowel Disease and Long-term Risk of Cancer: A Prospective Cohort Study Among Half a Million Adults in UK Biobank

May 31, 2022Inflammatory bowel diseases

Long-term cancer risk linked to inflammatory bowel disease in 500,000 UK adults

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Abstract

Among 455,927 participants, 5,142 were diagnosed with inflammatory bowel disease (IBD), leading to 890 cases of incident cancer during a median follow-up of 12.2 years.

IBD patients had a cancer incidence rate of 15.74 cases per 1000 person years, compared to 12.46 cases per 1000 person years in non-IBD individuals.
The adjusted hazard ratio for overall cancer mortality in IBD patients was 1.17, indicating a higher risk compared to non-IBD patients.
Cancer-specific mortality for IBD patients had an adjusted hazard ratio of 1.26, suggesting increased risk of death from cancer.
Increased risks were noted for specific cancer types, including digestive cancers (hazard ratio of 1.33), nonmelanoma cancers (1.25), and male genital cancers (1.29) in IBD patients.

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BACKGROUND: This study aims to examine the prospective association of inflammatory bowel disease (IBD) with long-term risk of overall, site-specific cancer and cancer-specific mortality in middle-aged and older people.

METHODS: The study included participants free of any cancer at baseline from the UK Biobank, with IBD patients as an exposure group and non-IBD patients as a reference group. Primary outcome was the incidence of overall cancer and cancer-specific mortality. Secondary outcomes included site-specific cancers and types of digestive cancers. Cox proportional hazard model was used to investigate the associated risk of incident malignancies and related mortality.

RESULTS: Among 455 927 participants, 5142 were diagnosed with IBD (3258 ulcerative colitis [UC]; 1449 Crohn's disease [CD]; others unspecified). During a median of 12.2-year follow-up, 890 cases of incident cancer were identified in IBD patients (15.74 per 1000 person years) compared with 63 675 cases in reference individuals (12.46 per 1000 person years). Of these cases, 220 and 12 838 cancer-specific deaths occurred in IBD and non-IBD groups. Compared with non-IBD participants, the adjusted hazard ratio (AHR) for overall cancer and cancer-specific mortality was 1.17 (95% CI, 1.09-1.25) and 1.26 (95% CI, 1.18-1.35) among IBD patients, with an AHR of 1.15 (95% CI, 1.02-1.31) and 1.38 (95% CI, 1.08-1.75) in UC and 1.15 (95% CI, 1.06-1.25) and 1.25 (95% CI, 1.06-1.49) in CD, respectively. Specifically, increased risk of digestive (1.33; 95% CI, 1.12-1.57), nonmelanoma (1.25; 95% CI, 1.11-1.41), and male genital (1.29; 95% CI, 1.09-1.52) cancers was observed in IBD patients.

CONCLUSIONS: Compared with non-IBD, IBD may be associated with an increased risk of overall cancer and cancer-specific mortality, particularly digestive cancers, nonmelanoma and male genital cancers.

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Inflammatory Bowel Disease and Long-term Risk of Cancer: A Prospective Cohort Study Among Half a Million Adults in UK Biobank

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