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Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014
Sachs’ Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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2017 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, ISSN 0959-8138, Vol. 358, article id j3951Article in journal (Refereed) Published
Abstract [en]

Objective: To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood.

Design: Cohort study with matched general population reference individuals using multivariable Cox regression to estimate hazard ratios.

Setting: Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014.

Participants: Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn's disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county.

Main outcome measures: Any cancer and cancer types according to the Swedish Cancer Register.

Results: During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn's disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2).

Conclusion: Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017. Vol. 358, article id j3951
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-61636DOI: 10.1136/bmj.j3951ISI: 000411858200003PubMedID: 28931512Scopus ID: 2-s2.0-85030424588OAI: oai:DiVA.org:oru-61636DiVA, id: diva2:1150226
Funder
Swedish Society of MedicineSwedish Cancer SocietySwedish Research CouncilSwedish Foundation for Strategic Research
Note

Funding Agencies:

Swedish Medical Society (fund for research in gastroenterology)  

Swedish Medical Society (Ihre Foundation)  

Mag-tarmfonden  

Jane and Dan Olsson Foundation  

Mjölkdroppen Foundation  

Bengt Ihre Research Fellowship in gastroenterology and Karolinska Institutet Foundations  

Stockholm County Council  

Karolinska Institutet (ALF) 

Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2018-02-12Bibliographically approved

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Ludvigsson, Jonas F.

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