People with inflammatory bowel disease (IBD) and precancerous colorectal lesions are at significantly increased risk of developing colorectal cancer, according to a new study. The research, led by NYU Langone Health, highlights that the degree of risk is directly linked to the initial grade of these precancerous lesions, known as dysplasia, emphasizing the critical need for ongoing monitoring.
The study provides what researchers describe as the most precise risk estimates to date, potentially leading to refined guidelines for colon cancer screening frequency among IBD patients based on their individual risk levels. Published in Clinical Gastroenterology and Hepatology, the investigation followed patients for nearly 15 years and found a strong correlation between the severity of initial dysplasia and the likelihood of progressing to advanced dysplasia or colorectal cancer.
Specifically, individuals with low-grade precancerous lesions were 3.5 times more likely to develop advanced dysplasia or colorectal cancer compared to those without any lesions. For those initially diagnosed with high-grade dysplasia, a concerning 40 percent developed colorectal cancer during the study period. Dysplasia refers to abnormal-looking cells that, while not yet cancerous, indicate an increased risk of developing into cancer.
“While we have long known that dysplasia increases cancer risk in IBD, the exact level of danger for each grade has been unclear,” explained Dr. Jordan Axelrad, associate professor in the Department of Medicine at NYU Grossman School of Medicine and co-director of NYU Langone’s Inflammatory Bowel Disease Center. “Our work provides robust, long-term data that can help doctors and patients make more informed decisions about the frequency of cancer screening and potential interventions.”
Inflammatory bowel disease encompasses two chronic conditions – ulcerative colitis and Crohn’s disease – both characterized by persistent inflammation of the digestive tract. The Centers for Disease Control and Prevention estimates that approximately 3 million adults in the United States are affected by these conditions. For these patients, the study underscores the importance of adhering to the colonoscopy schedule recommended by their gastroenterologist to facilitate early detection and removal of precancerous cells.
Nationwide Study Provides Detailed Risk Data
The research team leveraged data from a national registry in Sweden to analyze the health outcomes of over 54,000 individuals diagnosed with IBD. This nationwide approach offers a more comprehensive and potentially less biased picture compared to studies conducted at single hospitals, which may not fully represent the broader patient population.
Patients were categorized based on their initial pathology reports, which detail microscopic examination of tissue samples, into groups with no dysplasia, indefinite dysplasia, low-grade dysplasia, and high-grade dysplasia. The team then tracked each group for a median of nearly 15 years to monitor the development of advanced dysplasia or colorectal cancer.
Statistical models were employed to calculate the risk of progression for each group, accounting for factors such as sex, age, the extent of IBD, and other relevant medical conditions. This allowed researchers to isolate the specific risk associated with different grades of dysplasia.
“Our next goal is to see if You can build a personalized risk calculator based on these findings,” Dr. Axelrad stated. “Such a tool could help clinicians better tailor colonoscopy surveillance plans for each patient, potentially catching dangerous changes earlier while avoiding unnecessary procedures for those at lower risk.”
Dr. Adam Faye, assistant professor in the Department of Medicine and director of clinical research at NYU Langone’s IBD Center, also contributed to the study, which was a collaborative effort with researchers at Karolinska Institutet and Örebro University. Funding for the research was provided by the Crohn’s and Colitis Foundation, the Judith and Stewart Colton Center for Autoimmunity, National Institutes of Health grants K23DK124570 and K76AG083286, and the American College of Gastroenterology.
Recent research, published in Translational Gastroenterology and Hepatology on , also highlights the importance of updated colon cancer screening and surveillance for IBD patients, noting that the pathogenesis of colorectal cancer in IBD differs from sporadic cancer, with inflammation playing a key role. A study published on in The Lancet found a pooled colorectal cancer incidence of 1.47 per 1000 person-years in ulcerative colitis patients, emphasizing the elevated risk.
The American Gastroenterological Association (AGA) also released a clinical practice update in to help physicians understand the risk of cancer in IBD patients and guide management of those with active malignancy or a history of cancer.
About NYU Langone Health
NYU Langone Health is a fully integrated health system recognized for consistently achieving excellent patient outcomes through a strong commitment to quality. It has been ranked No. 1 among comprehensive academic medical centers nationally by Vizient Inc. For four consecutive years and has received high rankings from U.S. News & World Report for several clinical specialties. NYU Langone provides a wide range of medical services across multiple locations in New York and Florida, and includes two tuition-free medical schools and a substantial research enterprise.
Media Inquiries: Lacy Scarmana, Phone: 646-754-7367, Lacy.Scarmana@NYULangone.org
