New, long-term data offers the most precise estimates to date of colorectal cancer risk for individuals with inflammatory bowel disease (IBD) and precancerous lesions, a study published today in Clinical Gastroenterology and Hepatology reveals.
Researchers at NYU Langone Health found that the risk of developing colorectal cancer is directly tied to the initial grade of dysplasia – abnormal cell growth that isn’t yet cancer – present in IBD patients. The findings underscore the critical need for regular monitoring and could lead to more tailored screening guidelines, according to the study authors.
The nationwide study, conducted in Sweden, tracked the health of over 54,000 people diagnosed with IBD for nearly 15 years. Researchers analyzed pathology reports to categorize patients based on their initial dysplasia findings: no dysplasia, indefinite dysplasia, low-grade dysplasia, and high-grade dysplasia.
Over the study period, patients with low-grade precancerous lesions were 3.5 times more likely to develop advanced dysplasia or colorectal cancer compared to those with no such lesions. A significantly higher proportion, 40 percent, of those initially diagnosed with high-grade dysplasia developed colorectal cancer.
“While we have long known that dysplasia increases cancer risk in IBD, the exact level of danger for each grade has been unclear,” said Dr. Jordan Axelrad, lead author of the study, associate professor in the Department of Medicine at NYU Grossman School of Medicine, and co-director of NYU Langone’s Inflammatory Bowel Disease Center. “Our work provides robust, long-term data that can help doctors and patients make more informed decisions about the frequency of cancer screening and potential interventions.”
IBD encompasses two chronic conditions, ulcerative colitis and Crohn’s disease, which cause persistent inflammation of the digestive tract. The Centers for Disease Control and Prevention estimates that approximately 3 million adults in the United States are affected by these conditions.
The study team employed statistical models to calculate risk for each group, accounting for factors such as age, sex, the extent of IBD, and other related medical conditions to isolate the impact of dysplasia grade. The use of a national registry, researchers noted, provided a more comprehensive view than studies limited to single hospitals.
“Our next goal is to see if we can build a personalized risk calculator based on these findings,” Dr. Axelrad stated. “Such a tool could help clinicians better tailor colonoscopy surveillance plans for each patient, potentially catching dangerous changes earlier while avoiding unnecessary procedures for those at lower risk.”
Dr. Adam Faye, assistant professor in the Department of Medicine and director of clinical research at NYU Langone’s IBD Center, also contributed to the research, which was a collaboration with researchers at Karolinska Institutet and örebro University. Funding for the study was provided by the Crohn’s and Colitis Foundation, the Judith and Stewart Colton Center for Autoimmunity, National Institutes of Health grants K23DK124570 and K76AG083286, and the American College of Gastroenterology.