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High Frequency of Early Colorectal Cancer in Inflammatory Bowel Disease
  1. Maurice W M D Lutgens (mlutgens{at}umcutrecht.nl)
  1. University Medical Centre Utrecht, Netherlands
    1. Frank P Vleggaar (f.vleggaar{at}umcutrecht.nl)
    1. University Medical Centre Utrecht, Netherlands
      1. Marguerite E I Schipper (m.e.i.schipper{at}umcutrecht.nl)
      1. University Medical Centre Utrecht, Netherlands
        1. Pieter C F Stokkers
        1. Academic Medical Centre, University of Amsterdam, Netherlands
          1. Janneke van der Woude (c.vanderwoude{at}erasmusmc.nl)
          1. Erasmus Medical Centre Rotterdam, Netherlands
            1. Daan W Hommes (d.w.hommes{at}lumc.nl)
            1. Leiden University Medical Centre, Netherlands
              1. Dirk J de Jong
              1. Radboud University Nijmegen Medical Centre, Netherlands
                1. Gerard Dijkstra (g.dijkstra{at}int.umcg.nl)
                1. University Medical Centre Groningen, Netherlands
                  1. Ad A van Bodegraven (v.bodegraven{at}vumc.nl)
                  1. VU University Medical Centre Amsterdam, Netherlands
                    1. Bas Oldenburg (boldenbu{at}umcutrecht.nl)
                    1. University Medical Centre Utrecht, Netherlands
                      1. Melvin Samsom (m.samsom{at}umcutrecht.nl)
                      1. University Medical Centre Utrecht, Netherlands

                        Abstract

                        Background & Aim: To detect precancerous dysplasia or asymptomatic cancer, patients suffering from inflammatory bowel disease often undergo colonoscopic surveillance based on American or British guidelines. It is recommended to initiate surveillance after 8-10 years of extensive colitis, or after 15-20 years for left-sided disease. These starting points, however, are not based on solid scientific evidence. Our aim was to assess the time-interval between onset of inflammatory bowel disease (IBD) and colorectal carcinoma (CRC), and subsequently evaluate how many patients developed cancer before their surveillance was recommended to commence.

                        Methods: A nationwide automated pathology database was consulted to identify patients with IBD-associated colorectal carcinoma in 7 university medical centers in the Netherlands between January 1990 and June 2006. Data were collected retrospectively from patient charts. Time-intervals between onset of disease and cancer diagnosis were calculated in months.

                        Results: 149 patients were identified with confirmed diagnoses of IBD and CRC (ulcerative colitis n=89 / Crohn's disease n=59 / indeterminate colitis n=1). Taking date of diagnosis as entry-point, 22% of patients developed cancer before the 8 or 15 year starting points of surveillance, and 28% if surveillance would commence 10 or 20 years after diagnosis for extensive or left-sided disease respectively. Using onset of symptoms to calculate the time-interval, 17%-22% of patients would present with cancer prior to surveillance starting points.

                        Conclusions: These results show that the diagnosis of colorectal cancer is delayed or missed in a substantial number of patients (17-28%) when conducting surveillance strictly according to formal guidelines.

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