Gastroenterology

Gastroenterology

Volume 119, Issue 3, September 2000, Pages 647-653
Gastroenterology

Alimentary Tract
Hodgkin's disease risk is increased in patients with ulcerative colitis,☆☆

https://doi.org/10.1053/gast.2000.16487Get rights and content

Abstract

Background & Aims: All patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) residing in Florence, Italy, in 1978–1992 were identified and included in a population-based study of cancer risk evaluation. Methods: A total of 920 patients were followed up (median, 11 years), and 64 newly diagnosed malignancies were identified by linkage to the local cancer registry. Expected cases were calculated on the basis of age- and sex-specific cancer incidence rates to estimate relative risks in comparison with the general population. Results: Overall, cancer incidence rates were not increased. A significant excess risk of Hodgkin's disease was observed among patients with UC (standardized incidence ratio, 9.3; 95% confidence interval [CI], 2.5–23.8). Respiratory tract cancers were significantly reduced to one fourth of the expected rate in patients with UC, but tended to be increased among patients with CD, who had a 50% higher risk of cancer at all sites. Only a nonsignificant, modestly increased risk of colorectal cancer was observed. Conclusions: A strongly increased risk of Hodgkin's disease was evident in this first cancer follow-up of a representative series of patients with UC in a Mediterranean country. Two divergent risk patterns of respiratory tract cancers, possibly explained by differences in smoking habits, emerged in the 2 inflammatory bowel diseases.

GASTROENTEROLOGY 2000;119:647-653

Section snippets

Patients and methods

A previous population-based epidemiologic study identified all patients aged 15 years or older with a diagnosis of UC or CD residing in the metropolitan area of Florence during the period 1978–1992.1 At the last national census in 1991, the population included approximately 550,000 residents in that age range. The whole study area is covered by the Tuscany Cancer Registry and by the Regional Mortality Registry, both run at Centro per lo Studio e la Prevenzione Oncologica in Florence.

A total of

Results

A total of 920 patients with IBD (689 patients with UC and 231 patients with CD) were identified as residing in the area at any time during the period 1978–1992 and followed up from enrollment until death or until December 31, 1997, with a median follow-up of 11 years (range, 5–19 years). Only 5 patients (0.5 %) were lost to follow-up at that date.

Discussion

The cancer follow-up results of this population-based cohort are substantially similar to those obtained by similar larger studies in northern Europe, but suggest a strongly increased risk of HD among patients with IBD in this Mediterranean area. Two opposite risk patterns for smoke-related cancers (respiratory tract and bladder) emerged in our series of patients with UC and CD, whereas only a modestly increased risk of colorectal cancer was evident in both groups. Cancer follow-up of this

Acknowledgements

The authors thank the local association of IBD patients (AMICI) for support and cooperation; the Florence IBD Study Group (in particular G. Bardazzi, A. O. Careggi; A. Ghetti, ASL 10; G. Nesi and F. Tonelli, University of Florence); the Tuscany Cancer Registry (RTT-CSPO, A. O. Careggi, Florence); and C. Zappitello for editorial assistance.

References (36)

  • D Pinczowski et al.

    Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study

    Gastroenterology

    (1994)
  • E Langholz et al.

    Colorectal cancer risk and mortality in patients with ulcerative colitis

    Gastroenterology

    (1992)
  • G Trallori et al.

    A population-based study of inflammatory bowel disease in Florence over 15 years (1978—92)

    Scand J Gastroenterol

    (1996)
  • D Palli et al.

    General and cancer specific mortality of a population based cohort of patients with inflammatory bowel disease: the Florence Study

    Gut

    (1998)
  • J Stewénius et al.

    Incidence of colorectal cancer and all cause mortality in non-selected patients with ulcerative colitis and indeterminate colitis in Malmo, Sweden

    Int J Colorectal Dis

    (1995)
  • L Mellemkjaer et al.

    Cancer in patients with ulcerative colitis

    Int J Cancer

    (1995)
  • A Ekbom et al.

    Ulcerative colitis and colorectal cancer. A population-based study

    N Engl J Med

    (1990)
  • AJ Greenstein et al.

    Extraintestinal cancers in inflammatory bowel disease

    Cancer

    (1985)
  • Cited by (124)

    • The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies

      2021, Clinical Gastroenterology and Hepatology
      Citation Excerpt :

      The meta-analysis found an increased risk of malignancy in the bile duct among UC and CD patients (IRR, 2.93 [95% CI, 1.73–4.98] and 2.93 [95% CI, 1.16–7.41], respectively), although only UC patients were at increased risk of hepatobiliary (and pancreatic) malignancies (IRR, 2.05 [95% CI, 1.52–2.76]) (Supplementary Figures 12 and 13). The majority of studies observed an increased risk of hematologic malignancies in both CD and UC patients.13,14,16,20,21,23,31,33–35,41,42,44 The risk of non-Hodgkin lymphomas was found to be especially higher in IBD patients, particularly those with CD.13,14,16,20,21,23,31,33,34,40–42,44

    View all citing articles on Scopus

    Address requests for reprints to: Domenico Palli, M.D., Epidemiology Unit, CSPO, Via di San Salvi 12, 50131 Firenze, Italy. e-mail: [email protected]; fax: (39) 055-67-99-54.

    ☆☆

    Supported by Regione Toscana.

    View full text