title: Incidence, management, and course of cancer in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Patients with inflammatory bowel disease [IBD] are at increased risk for developing some types of neoplasia. Our aims were to determin the risk for cancer in patients with IBD and to describe the relationship with immunosuppressive therapies and clinical management after tumor diagnosis.
  
  
  METHODS
  Retrospective, multicenter, observational, 5-year follow-up, cohort study. Relative risk [RR] of cancer in the IBD cohort and the background population, therapeutic strategies, and cancer evolution were analyzed.
  
  
  RESULTS
  A total of 145 cancers were diagnosed in 133 of 9100 patients with IBD (global cumulative incidence 1.6% vs 2.4% in local population; RR = 0.67; 95% confidence interval [CI]: 0.57-0.78). Patients with IBD had a significantly increased RR of non-melanoma skin cancer [RR = 3.85; 2.53-5.80] and small bowel cancer [RR = 3.70; 1.23-11.13]. After cancer diagnosis, IBD treatment was maintained in 13 of 27 [48.1%] patients on thiopurines, in 2 of 3 on methotrexate [66.6%], none on anti-TNF-α monotherapy [n = 6] and 4 of 12 [33.3%] patients on combined therapy. Rate of death and cancer remission during follow-up did not differ [p > 0.05] between patients who maintained the treatment compared with patients who withdrew [5% vs 8% and 95% vs 74%, respectively]. An association between thiopurines [p = 0.20] or anti-TNF-α drugs [p = 0.77] and cancer was not found.
  
  
  CONCLUSIONS
  Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis.
authors: Departments of Gastroenterology: Hospital Universitario de Fuenlabrada alicia_algaba@hotmail.com.
authors: Alicia
authors: A
authors: Algaba
authors: Departments of Gastroenterology: Hospital Universitario de Fuenlabrada.
authors: Iván
authors: I
authors: Guerra
authors: Hospital Universitario Gregorio Marañón.
authors: Ignacio
authors: I
authors: Marín-Jiménez
authors: Hospital Universitario Severo Ochoa.
authors: Elvira
authors: E
authors: Quintanilla
authors: Hospital Universitario Fundación Alcorcón.
authors: Pilar
authors: P
authors: López-Serrano
authors: Hospital Universitario Ramón y Cajal.
authors: María Concepción
authors: MC
authors: García-Sánchez
authors: Hospital Universitario 12 de Octubre.
authors: Begoña
authors: B
authors: Casis
authors: Hospital Clínico San Carlos, IdISSC.
authors: Carlos
authors: C
authors: Taxonera
authors: Hospital Príncipe de Asturias.
authors: Ignacio
authors: I
authors: Moral
authors: Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa [IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD].
authors: María
authors: M
authors: Chaparro
authors: Hospital Universitario Infanta Cristina.
authors: Daniel
authors: D
authors: Martín-Rodríguez
authors: Hospital Universitario La Paz.
authors: María Dolores
authors: MD
authors: Martín-Arranz
authors: Hospital Universitario Infanta Sofía.
authors: Noemí
authors: N
authors: Manceñido
authors: Hospital Universitario Gregorio Marañón.
authors: Luis
authors: L
authors: Menchén
authors: Hospital Universitario Ramón y Cajal.
authors: Antonio
authors: A
authors: López-Sanromán
authors: Department of Pathology. Hospital Universitario de Fuenlabrada; Madrid, Spain.
authors: Ángel
authors: Á
authors: Castaño
authors: Departments of Gastroenterology: Hospital Universitario de Fuenlabrada.
authors: Fernando
authors: F
authors: Bermejo
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents
keywords: Inflammatory bowel disease; anti-TNF-drugs; cancer risk; thiopurines