Irritable Bowel Diseases Sharply Boost Risk of Pancreatic Cancer
Elsevier Global Medical News. 2010 May 3, M SullivanNEW ORLEANS (EGMN) - Patients with irritable bowel disease are significantly more likely than the general population to develop pancreatic cancer, according to the first prospective study to assess standardized incidence rates of both disorders.
Men with ulcerative colitis are at a particularly high risk - more than 6 times as likely to develop pancreatic cancer as are men without ulcerative colitis, Dr. Jason Schwartz said May 3 at the annual Digestive Disease Week.
If the data are confirmed in larger studies, they may justify population-based screening for patients with either ulcerative colitis or Crohn's disease - particularly men. "It's too early right now to make screening recommendations, but providers should keep in mind that males with ulcerative colitis may harbor an inclination to develop pancreatic cancer," said Dr. Schwartz of the University of Utah, Salt Lake City. "Perhaps in the future, this study may open the door to screening for pancreatic cancer in patients with irritable bowel disease, similar to what we now do for patients with IBD who have an increased risk of colon cancer."
Dr. Schwartz and his colleagues extracted 10-year data on irritable bowel disease and pancreatic cancer cases in Utah from the University of Utah Health Care system and the Utah Cancer Registry.
From 1996 to 2006, there were 2,877 adult cases of irritable disease in the database. The investigators then matched these cases to pancreatic cancer cases in the cancer registry and the Utah population database. "What we found was striking and unexpected," Dr. Schwartz said. "We felt there would be an association, but we were surprised by the strength of it."
The investigators found 12 cases with both IBD and pancreatic cancer. Even after excluding five cases - because the cancer was diagnosed before the IBD - the association remained strong. "The expected rate of pancreatic cancer in Utah is 4/100,000 person-years," Dr. Schwartz said. "The association that we saw worked out to be 7/15,000 person-years."
All of these cases occurred in men with ulcerative colitis. So while the overall risk for pancreatic cancer in any patient with either ulcerative colitis or Crohn's disease was 3.4, men with ulcerative colitis were 6.22 times more likely to develop the cancer than were men without ulcerative colitis.
The pathologic connection between IBD and pancreatic cancer has not been fully explored. However, repeated bouts of inflammation probably are involved, he said. "The intestines also become more permeable and allow bacteria to come into contact with the pancreas and liver," which may contribute to the process, Dr. Schwartz said.