Mesalamine protects against colorectal cancer in inflammatory bowel disease.
BACKGROUND
Individuals with inflammatory bowel disease (IBD) are at increased risk of developing colorectal cancer (CRC) compared with the general population. Previous studies show this risk is strongly associated with dysplasia, extent of disease, duration of disease, and degree of inflammation, while chemoprevention of CRC has less support.


OBJECTIVE
Evaluate factors influencing risk of colorectal cancer development in inflammatory bowel disease patients.


METHODS
IBD patients with CRC were matched to controls by IBD type, age at diagnosis, sex, race, extent of disease, and disease duration. We compared body mass index, family history of IBD, family history of CRC, tobacco use, and cumulative and daily use of aminosalicylates, immunomodulators, folic acid, steroids, and nonsteroidal anti-inflammatory drugs. Statistical analysis was performed with logistic regression and receiver operating characteristic (ROC) curves.


RESULTS
Of 1,594 IBD patients, 30 CRC patients were identified. Of these, 18 CRC patients were matched to 30 controls. More control patients used a cumulative aminosalicylate dose of >or=4,500 g (46.6% versus 5.6%; P = 0.047), folic acid (40.0% versus 16.7%; P = 0.002), cumulative folic acid dose of >or=1,400 mg (30.0% versus 11.1%; P = 0.014), and average daily folic acid dose of >or=1 mg (30.0% versus 16.7%; P = 0.002) compared with CRC patients. Multivariate analysis showed that a cumulative aminosalicylate dose of >or=4,500 g reduced the risk of CRC by 97.6% (P = 0.047). Folic acid reduced CRC risk by 89% (P = 0.002).


CONCLUSIONS
Aminosalicylate and folic acid use may decrease the risk of CRC among IBD patients.
Tang
Jeffrey
J
Department of Internal Medicine, Division of Gastroenterology, Henry Ford Health System, Henry Ford Hospital, Detroit, MI 48202, USA. jtang2@hfhs.org
Sharif
Omar
O
Pai
Chetan
C
Silverman
Ann L
AL
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000209:etiology / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016588:Anticarcinogenic Agents; D005765:Gastrointestinal Agents; D019804:Mesalamine; D005492:Folic Acid
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