Risk of rectal, anal cancer increased in perianal CD

In a Danish nationwide study, 17% of Crohn’s disease (CD) patients developed perianal CD. The risk of rectal or anal cancer was increased in patients with perianal CD compared with non- inflammatory bowel disease (IBD) matched controls. These findings highlight the need for surveillance of rectal and anal cancer.

The aim of this study was to assess the incidence and course of perianal CD in adult patients, and to describe changes in medical and surgical management as well as rates of cancer [1]. The cohort comprised all individuals >18 years diagnosed with CD in Denmark within a 19-year period (1997-2016). Of 9,739 CD patients, 1,697 (17%) had perianal CD. Perianal fistulas accounted for 943 cases (56%). The overall incidence of perianal CD was 20/1,000 patient-years and remained stable over time. More patients with perianal CD than without were treated with immunomodulators (70% vs 51%; P<0.001) and biologics (35% vs 15%; P<0.001). The continuing high incidence of perianal CD suggests disease-modifying effects of biologics are limited, according to the authors. Patients with perianal CD had a significantly higher risk of undergoing major abdominal surgery than patients without perianal CD (HR 1.52; 95% CI 1.40-1.65; P<0.001).

The incidence rate ratios of anal and rectal cancer in perianal CD patients were 12.46 (95% CI 5.07-30.59; P<0.001) and 2.41 (95% CI 1.31-4.42; P=0.003) respectively, compared with non-IBD matched controls. The incidence rate ratios of anal and rectal cancer in perianal CD patients were 2.36 (95% CI 0.86-6.50; P=0.09) and 1.35 (95% CI 0.68-2.68; P=0.38) respectively, compared with CD patients without perianal CD.

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   1. Wewer MD, et al. ECCO-IBD 2020, OP12.

Posted on 14 April 202017 May 2024