title: Inflammatory bowel disease, cancer and medication: Cancer risk in the Dutch population-based IBDSL cohort.
abstract: The management of inflammatory bowel disease (IBD) has changed since the mid-1990s (e.g., use of thiopurines/anti-TNFα agents, improved surveillance programs), possibly affecting cancer risk. To establish current cancer risk in IBD, updates are warranted from cohorts covering this time span, and detailed enough to study associations with phenotype and medication. We studied intestinal-, extra-intestinal- and overall cancer risk in the Dutch population-based IBDSL cohort. In total, 1,157 Crohn's disease (CD) and 1,644 ulcerative colitis (UC) patients were diagnosed between 1991 and 2011, and followed until 2013. Standardized incidence ratios (SIRs) were calculated for CD and UC separately, as well as for gender-, phenotype-, disease duration-, diagnosis era- and medication groups. We found an increased risk for colorectal cancer in CD patients with colon involvement (SIR 2.97; 95% CI 1.08-6.46), but not in the total CD or UC population. In addition, CD patients were at increased risk for hematologic- (2.41; 1.04-4.76), overall skin- (1.55; 1.06-2.19), skin squamous cell- (SCC; 3.83; 1.83-7.04) and overall cancer (1.28; 1.01-1.60), whereas UC patients had no increased risk for extra-intestinal- and overall cancer. Finally, in a medication analysis on CD and UC together, long-term immunosuppression exposure (>12 months) was associated with an increased risk for hematologic cancer, non-Hodgkin lymphoma, SCC and overall cancer, and this increase was mainly attributed to thiopurines. IBD patients with long-term immunosuppression exposure can be considered as having a higher cancer risk, and our data support the advice in recent IBD guidelines to consider skin cancer screening in these patients.
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.|NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Tim R A
authors.initials: TR
authors.lastname: van den Heuvel
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Dion S J
authors.initials: DS
authors.lastname: Wintjens
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.|NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Steven F G
authors.initials: SF
authors.lastname: Jeuring
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Maartje H H
authors.initials: MH
authors.lastname: Wassink
authors.affiliation: Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Marielle J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.affiliation: Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Liekele E
authors.initials: LE
authors.lastname: Oostenbrug
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Wim H
authors.initials: WH
authors.lastname: Hameeteman
authors.affiliation: NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.|Department of Complex Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Maurice P
authors.initials: MP
authors.lastname: Zeegers
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.|NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: Masclee
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.|NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Daisy M
authors.initials: DM
authors.lastname: Jonkers
authors.affiliation: Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.|NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Pierik
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D009426:Netherlands / Q000453:epidemiology; D010641:Phenotype; D011159:Population Surveillance; D012306:Risk
keywords: Crohn's disease; cancer; epidemiology; immunosuppression; inflammatory bowel disease; population based; ulcerative colitis