A154 Cancers Associated With Inflammatory Bowel Disease in Canada: A Population-Based Analysis of Cases and Matched Controls

Abstract

Background Individuals with inflammatory bowel disease (IBD) are known to have a higher risk of digestive tract cancers and cancers associated with immunosuppression. As the IBD population is ageing, age-related cancers may be more commonly diagnosed. Purpose To assess whether IBD patients were at a higher odds of incident cancers than their matched controls stratified by age above and below 65 years. Method A population-based surveillance study was conducted in Alberta, Canada (April 1, 2002 to March 30, 2018). A validated algorithm identified cases of IBD. Each case was age and sex matched to up to 10 non-IBD cases from the general population and linked to the Alberta provincial cancer registry to extract pathology-confirmed incident cancer. Controls were removed if they were not residents of Alberta at the time the matched case was diagnosed with IBD. Only incident cancers diagnosed after the diagnosis of IBD (or matched indexed date for controls) were considered. Age was calculated based on year of inclusion in the cohort or, if applicable, the year of cancer diagnosis. Cancer diagnoses were classified: bladder, biliary and liver, breast, cervix, colorectal, endometrium, gastrointestinal, gynecological, head and neck, hematological, kidney, lung, melanoma, neurological, non-melanoma, pancreas, prostate, renal and bladder, small intestine, thyroid, and miscellaneous. Odds ratios (OR), with 95% confidence intervals (CI), compared IBD cases to matched controls using conditional logistic regression. Stratified analysis at age 65 (<65 and ≥65) was done for all cancers. Result(s) Overall, 3695 incident cancers were diagnosed among 35,763 individuals with IBD as compared to 22,687 cancers among 289,212 controls (OR:1.12; 95%CI: 1.08, 1.16). Those less than 65 years old were at higher odds of developing cancer (1.20; 95%CI: 1.15, 1.26) than those ≥65 (0.97; 95%CI: 0.90, 1.04). Those with IBD had a higher odds biliary and liver (7.41; 95%CI: 5.58, 9.84) and gastrointestinal (2.26; 95%CI: 2.06, 2.48), which including: colorectal (1.78; 95%CI: 1.57, 2.02), pancreas (7.79; 95%CI: 5.53, 10.97), and small intestine (6.59; 95%CI: 4.65, 9.35). Melanoma and non-melanoma, head and neck, and thyroid cancers did not have an increased odds but hematological, lung, neurological, and kidney cancers did show an increased odds among those with IBD. Cancers outside of the gastrointestinal tract were at a lower odds for IBD patients, including: bladder (0.68; 95%CI: 0.54, 0.87), breast (0.72; 95%CI: 0.64, 0.81), gynecological (incl. cervix (0.68; 95%CI: 0.61, 0.78) and endometrium (0.48; 95%CI: 0.34, 0.66), and prostate (0.64; 95%CI: 0.57, 0.73). Image Conclusion(s) Under the age of 65, individuals with IBD have a higher odds of being diagnosed with cancer than the general population, with cancers of the digestive tract driving this association across the age spectrum. Healthcare providers should be aware of higher occurrence of hematological, neurological, lung and renal cancers in those with IBD. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest S. Coward: None Declared, S. Murthy: None Declared, H. Singh Consultant of: Pendopharm, Amgen Canada, Bristol Myers Squibb Canada, Roche Canada, Sandoz Canada, Takeda Canada, and Guardant Health, Inc., E. Benchimol Consultant of: Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to medications used to treat inflammatory bowel disease and McKesson Canada and the Dairy Farmers of Ontario for matters unrelated to medications used to treat inflammatory bowel disease., E. Kuenzig: None Declared, G. Kaplan Grant / Research support from: Ferring, Janssen, AbbVie, GlaxoSmith Kline, Merck, and Shire, Consultant of: Gilead, Speakers bureau of: AbbVie, Janssen, Pfizer, Amgen, and Takeda

Meta‐analysis: Risk of pancreatic cancer in patients with inflammatory bowel disease

“…The results of the leave‐one‐out meta‐analysis for the primary study outcome have been summarised in Figure S2; no single study significantly influenced the risk estimate. The Galbraith plot identified one outlier study 23 (Figure S3), which might be due to being a conference abstract or the sole study reporting OR as an effect measure; after removing this study, the risk of pancreatic cancer was still increased in IBD (RR = 1.45 [95% CI: 1.18–1.79]), with moderate heterogeneity ( I 2 = 71.9%, p for χ 2 = 0.02). Finally, the annual incidence of pancreatic cancer caused by IBD increased by 55 cases (95% CI: 17–103) per million.…”

“…For this systematic review and meta-analysis, we screened 5201 citations from the initial database search. After excluding 5188 publications because of duplication or unsuitability, we identified 13 eligible articles, including 11 cohort studies regarding the first study aim 5,[8][9][10][11][22][23][24][25][26][27] and two studies concerning the second study aim. 28,29 The search strategy and process for study selection are illustrated in Figure 1.…”

“…There were two conference abstracts among the enrolled studies. 23,25 Finally, three studies had a high quality, five had a moderate quality and three had a low quality. The baseline characteristics and the quality evaluation of the included studies have been represented in Tables 1 and 2 and Table S1, respectively.…”

“…All studies used the specific International Classification of Diseases codes to diagnose pancreatic cancer with histological confirmation. There were two conference abstracts among the enrolled studies 23,25 . Finally, three studies had a high quality, five had a moderate quality and three had a low quality.…”

The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD

“…Most population-based studies have reported CRC risk to be elevated among persons with IBD as compared to age- and sex-similar persons without IBD ( 18 , 20 , 21 , 23 , 59 ). A meta-analysis of population-based studies up to 2009 reported a standardized incidence ratio (SIR) of 1.7 (95% confidence interval [CI]: 1.2, 2.2) for CRC among persons with IBD relative to the general population, which was similar across Crohn’s disease and ulcerative colitis ( 18 ).…”