Risk of cancer in patients with inflammatory bowel diseases: A nationwide population-based cohort study with 30 years of follow-up evaluation

Data regarding the risk of gastrointestinal and extra-intestinal cancers in Crohn’s disease (CD) and ulcerative colitis (UC) are needed to understand the clinical course of inflammatory bowel diseases (IBDs) and their treatments

Cancer risk and prognosis after a hospital contact for an elevated erythrocyte sedimentation rate

Background: An elevated erythrocyte sedimentation rate (ESR) may be a marker of occult cancer. Methods: We linked Danish medical databases to examine cancer incidence in patients with a first-time hospital contact for elevated ESR during 1980 to 2013. We calculated standardized incidence ratios (SIR) of cancer compared with the general population, and comorbidity-adjusted HRs (aHR) versus matched population comparisons without elevated ESR. We also compared survival among patients with cancer with elevated ESR with that among patients with cancer without elevated ESR. Results: During median follow-up of 4.9 years, we observed 3,926 cancers among 18,540 patients with a first-time hospital contact for elevated ESR. The risk for any cancer diagnosed during the first year following the contact for elevated ESR was 8.5% [95% confidence interval (CI) 8.1%–8.9%]. The overall 1-year cancer incidence was markedly elevated [SIR 5.3 (95% CI, 5.1–5.6); aHR 5.8 (95% CI, 5.4–6.3)] and was more than 3-fold elevated for most hematologic cancers and for cancers of the peritoneum and connective tissue in the abdominal wall, kidney, and adrenal glands. After the first year, patients were at increased risk of developing especially hematologic cancers. Patients diagnosed with cancer within 1 year after a contact for elevated ESR had poorer survival compared with matched cancer comparisons [adjusted mortality rate ratio 1.2 (95% CI, 1.1–1.3)]. Conclusions: Elevated ESR is a strong marker of undiagnosed cancer and is associated with poorer survival. Impact: Our findings may help clinicians in assessing absolute risk, common sites, and prognosis of cancers discovered after hospital contact with elevated ERS.</p

Superficial and deep venous thrombosis, pulmonary embolism and subsequent risk of cancer

BACKGROUND: In contrast to deep venous thrombosis and pulmonary embolism, superficial venous thrombosis has not been considered to be a marker of occult cancer. However, actual data regarding the association are very limited. METHODS: We identified all patients in Denmark from 1994 to 2009 with a diagnosis of superficial venous thrombosis, deep venous thrombosis in the legs or pulmonary embolism using population-based health registries. The occurrence of cancer in the three venous thromboembolism cohorts was compared with the expected numbers of cases estimated using national incidence rates to compute standardised incidence ratios (SIRs). FINDINGS: We identified a total of 7663 patients with superficial venous thrombosis, 45,252 with deep venous thrombosis and 24,332 with pulmonary embolism. In the first year of follow-up, very similar proportions of patients in the three cohorts were diagnosed with cancer. The SIR was 2.46 (95% CI, 2.10-2.86) for superficial venous thrombosis, 2.75 (95% CI, 2.60-2.90) for deep venous thrombosis, and 3.27 (95% CI, 3.03-3.52) for pulmonary embolism. After one year, the SIRs declined to 1.05 (95% CI, 0.96-1.16), 1.11 (95% CI 1.07-1.16) and 1.15 (95% CI, 1.09-1.22), respectively. For all three patient cohorts, particularly strong associations were found for cancers of the liver, lung, ovaries and pancreas as well as for non-Hodgkin's lymphoma. INTERPRETATION: Venous thrombosis, whenever it is seen in the lower limbs, is a preclinical marker of prevalent cancer, particularly during the first year after diagnosis

Risk of Cancer in Patients With Inflammatory Bowel Diseases: A Nationwide Population-based Cohort Study With 30 Years of Follow-up Evaluation

BACKGROUND & AIMS: Data regarding the risk of gastrointestinal and extra-intestinal cancers in Crohn’s disease (CD) and ulcerative colitis (UC) are needed to understand the clinical course of inflammatory bowel diseases (IBDs) and their treatments. METHODS: We performed a nationwide historical cohort study using Danish healthcare databases. We identified patients with a diagnosis of CD or UC, recorded from 1978 through 2010, and followed them until first occurrence of cancer, death, or emigration. We used standardized incidence ratios (SIRs) to compare cancer incidence in CD and UC patients to that expected in the general population. RESULTS: Excluding cancers diagnosed within 1 year of IBD diagnosis, 772 cases of invasive cancer occurred among 13,756 patients with CD (SIR, 1.3; 95% confidence interval [CI], 1.2–1.4) and 2331 occurred among 35,152 patients with UC (SIR, 1.1; 95% CI, 1.0–1.1). CD was weakly associated with gastrointestinal cancers (SIR 1.2; 95% CI, 1.0–1.4) and extra-intestinal cancers (SIR, 1.3; 95% CI, 1.2–1.4), with the strongest associations for hematological malignancies (SIR, 1.9; 95% CI, 1.5–2.3), smoking-related cancers (SIR 1.5, 95% CI 1.3–1.8), and melanoma (SIR, 1.4; 95% CI, 1.0–1.9). Associations between UC and gastrointestinal and extra-intestinal cancers were weaker (SIR, 1.1; 95% CI, 1.0–1.2 and SIR, 1.1; 95% CI, 1.0–1.1, respectively). The relative risk of extra-intestinal cancers among patients with IBD was relatively stable over time, although the risk of gastrointestinal cancers decreased. CONCLUSIONS: Patients with IBD, particularly CD, are at increased risk for gastrointestinal and extra-intestinal malignancies. The relative risk of gastrointestinal malignancy has deceased since 1978, without a concomitant increase in the risk of non-gastrointestinal malignancy