Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-019-05554-1 ORIGINAL ARTICLE Risk of Early Colorectal Cancers Needs to Be Considered in Infammatory Bowel Disease Care Shirley Cohen‑Mekelburg 1  · Yecheskel Schneider 2  · Stephanie Gold 3  · Gaurav Ghosh 3  · Russell Rosenblatt 4  · Kaveh Hajifathalian 4  · Ellen Scherl 4  · Felice Schnoll‑Sussman 4  · Philip Katz 4  · Adam Steinlauf 5 Received: 14 August 2018 / Accepted: 20 February 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Current guidelines recommend starting colorectal cancer (CRC) surveillance 8–10 years after infammatory bowel disease (IBD) onset. Recent studies report that the incidence of CRC within 8–10 years of IBD onset (i.e., early CRC) ranges from 12 to 42%. Aims To describe the current prevalence of early CRC in a tertiary care center IBD cohort with CRC and to identify associ- ated risk factors. Methods We performed a single-center observational study of IBD patients diagnosed with CRC from 2005 to 2015. We compared characteristics of patients with early CRC (diagnosis of CRC within 8 years of initial IBD onset) to those with CRC diagnosed later in their IBD course. Results Ninety-three patients met inclusion criteria. Eleven (11.8%) patients developed CRC within 8 years of initial IBD onset. On multivariable logistic regression, age greater than 28 at IBD onset (adjusted OR 12.0; 95% CI 2.30, 62.75) and tobacco use (adjusted OR 8.52; 95% CI 1.38, 52.82) were signifcant predictors of early CRC. A validation cohort confrmed calibration and discrimination of the model. Conclusions One out of every eight IBD patients with CRC developed their malignancy prior to the currently recommended timeframe for the initiation of surveillance colonoscopy. IBD onset at 28 years or older and tobacco use were identifed as predictors of early CRC. Early CRC should be considered in discussions of cancer surveillance in this population. Prospec- tive cohort studies are necessary to further analyze the impact of early CRC in IBD. Keywords Crohn’s disease · Ulcerative colitis · Malignancy · Carcinoma Introduction The risk of colorectal cancer (CRC) is higher among infam- matory bowel disease (IBD) patients than in the general population with an estimated overall prevalence of 3.7% [1, 2]. The pathogenesis of CRC in IBD follows an infam- mation–dysplasia–carcinoma sequence [3]. Multiple risk factors for CRC in the setting of IBD have been identifed, including extremes of age at IBD onset, family history of CRC, pseudopolyps, longer extent of disease, longer dura- tion of poorly controlled disease, concomitant primary sclerosing cholangitis (PSC), current age, and male gender [4–17]. One of the main risk factors associated with CRC is dura- tion of IBD. The cumulative risk, based on a systematic review from 2001, is 3–4.4% at 10 years of IBD duration, 5.9–8.6% at 20 years, and 8.7–12.7% at 30 years [1, 18]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-019-05554-1) contains supplementary material, which is available to authorized users. * Shirley Cohen-Mekelburg shcohen@umich.edu 1 Division of Gastroenterology and Hepatology, Michigan Medicine, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA 2 Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA 3 Department of Medicine, NewYork Presbyterian Weill Cornell Medicine, New York, NY, USA 4 Division of Gastroenterology and Hepatology, NewYork Presbyterian Weill Cornell Medicine, New York, NY, USA 5 Division of Gastroenterology and Hepatology, Mount Sinai Hospital, New York, NY, USA