title: The risk of cancer in patients with Crohn's disease.
abstract: OBJECTIVE
  The risk of cancer in patients with Crohn's disease is not well defined. Using meta-analytical techniques, the present study was designed to quantify the risk of intestinal, extraintestinal, and hemopoietic malignancies in such patients.
  
  
  METHODS
  A literature search identified 34 studies of 60,122 patients with Crohn's disease. The incidence and relative risk of cancer were calculated for patients with Crohn's disease and compared with the baseline population of patients without Crohn's disease. Overall pooled estimates, with 95 percent confidence intervals, were obtained, using a random-effects model.
  
  
  RESULTS
  The relative risk of small bowel, colorectal, extraintestinal cancer, and lymphoma compared with the baseline population was 28.4 (95 percent confidence interval, 14.46-55.66), 2.4 (95 percent confidence interval, 1.56-4.36), 1.27 (95 percent confidence interval, 1.1-1.47), and 1.42 (95 percent confidence interval, 1.16-1.73), respectively. On subgroup analysis, patients with Crohn's disease had an increased risk of colon cancer (relative risk, 2.59; 95 percent confidence interval, 1.54-4.36) but not of rectal cancer (relative risk, 1.46; 95 percent confidence interval, 0.8-2.55). There was significant association between the anatomic location of the diseased bowel and the risk of cancer in that segment. The risk of small bowel cancer and colorectal cancer was found to be higher in North America and the United Kingdom than in Scandinavian countries with no evidence of temporal changes in the cancer incidence.
  
  
  CONCLUSIONS
  The present meta-analysis demonstrated an increased risk of small bowel, colon, extraintestinal cancers, and lymphoma in patients with Crohn's disease. Patients with extensive colonic disease that has been present from a young age should be candidates for endoscopic surveillance; however, further data are required to evaluate the risk of neoplasia over time.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, St. Mary's Hospital, London, W2 1NY, UK.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: von Roon
authors.forename: George
authors.initials: G
authors.lastname: Reese
authors.forename: Julian
authors.initials: J
authors.lastname: Teare
authors.forename: Vasilis
authors.initials: V
authors.lastname: Constantinides
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
mesh_terms: D003424:Crohn Disease / Q000150:complications*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D018570:Risk Assessment