The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD

Sanjay K Murthy^{1

2}, M Ellen Kuenzig^{3

4}, Joseph W Windsor⁵, Priscilla Matthews⁶, Parul Tandon⁷, Eric I Benchimol^{3

4

8

9

10}, Charles N Bernstein^{11

12}, Alain Bitton¹³, Stephanie Coward⁵, Jennifer L Jones¹⁴, Gilaad G Kaplan⁵, Kate Lee¹⁵, Laura E Targownik¹⁶, Juan-Nicolás Peña-Sánchez¹⁷, Noelle Rohatinsky¹⁸, Sara Ghandeharian¹⁵, Saketh Meka¹⁹, Roxana S Chis⁷, Sarang Gupta²⁰, Eric Cheah²¹, Tal Davis^{3

4}, Jake Weinstein^{3

4}, James H B Im^{3

4}, Quinn Goddard⁵, Julia Gorospe⁵, Jennifer Loschiavo¹⁵, Kaitlyn McQuaid¹⁵, Joseph D'Addario¹⁵, Ken Silver¹⁵, Robyn Oppenheim¹⁵, Harminder Singh^{11

12

22

23}

Affiliations

¹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
² The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
³ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Gastroenterology and Hepatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ ICES, Toronto, Ontario, Canada.
⁹ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹¹ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹⁴ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁵ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹⁶ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁸ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁹ Department of Neuroscience, McGill University, Montreal, Quebec, Canada.
²⁰ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
²¹ Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital Melbourne, Parkville, Australia.
²² Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²³ CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.

PMID: 37674502
PMCID: PMC10478814
DOI: 10.1093/jcag/gwad006

Review

The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD

Sanjay K Murthy et al. J Can Assoc Gastroenterol. 2023.

. 2023 Sep 5;6(Suppl 2):S83-S96.

doi: 10.1093/jcag/gwad006. eCollection 2023 Sep.

Authors

Affiliations

¹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
² The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
³ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Gastroenterology and Hepatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ ICES, Toronto, Ontario, Canada.
⁹ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹¹ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹² IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹⁴ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁵ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹⁶ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁸ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁹ Department of Neuroscience, McGill University, Montreal, Quebec, Canada.
²⁰ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
²¹ Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital Melbourne, Parkville, Australia.
²² Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²³ CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.

PMID: 37674502
PMCID: PMC10478814
DOI: 10.1093/jcag/gwad006

Abstract

Cancer is a major cause of morbidity and mortality among people with inflammatory bowel disease (IBD). Intestinal cancers may arise as a complication of IBD itself, while extra-intestinal cancers may arise due to some of the immunosuppressive therapies used to treat IBD. Colorectal cancer (CRC) and small bowel cancer risks remain elevated among persons with IBD as compared to age-and sex-matched members of the general population, and the lifetime risk of these cancers is strongly correlated to cumulative intestinal inflammatory burden. However, the cumulative risk of cancer, even among those with IBD is still low. Some studies suggest that IBD-CRC incidence has declined over the years, possibly owing to improved treatment standards and improved detection and management of early neoplastic lesions. Across studies of extra-intestinal cancers, there are generally higher incidences of melanoma, hepatobiliary cancer, and lung cancer and no higher incidences of breast cancer or prostate cancer, with equivocal risk of cervical cancer, among persons with IBD. While the relative risks of some extra-intestinal cancers are increased with treatment, the absolute risks of these cancers remain low and the decision to forego treatment in light of these risks should be carefully weighed against the increased risks of intestinal cancers and other disease-related complications with undertreated inflammatory disease. Quality improvement efforts should focus on optimized surveillance of cancers for which surveillance strategies exist (colorectal cancer, hepatobiliary cancer, cervical cancers, and skin cancers) and the development of cost-effective surveillance strategies for less common cancers associated with IBD.

Keywords: Cancer; Crohn’s Disease; Screening; Surveillance; Ulcerative Colitis.

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Conflict of interest statement

Sanjay Murthy has previously participated in advisory board meetings for AbbVie, Janssen, Takeda, Pfizer, Shire and Ferring and as a speaker at educational events sponsored by Janssen, AbbVie and Pfizer. Ellen Kuenzig is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Eric Benchimol holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, The Hospital for Sick Children, and the SickKids Foundation. He has acted as a consultant for the Dairy Farmers of Ontario and McKesson Canada for matters unrelated to medications used to treat inflammatory bowel disease. He is Past Chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada and Editor-in-Chief of the Journal of the Canadian Association of Gastroenterology (JCAG). Charles Bernstein is supported in part by the Bingham Chair in Gastroenterology. He is on Advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb, JAMP Pharmaceuticals, Lilly Canada, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, Takeda Canada. He is a Consultant for Mylan Pharmaceuticals and Takeda. He has received educational grants from AbbVie Canada, Pfizer Canada, Takeda Canada, Janssen Canada, and Bristol Myers Squibb Canada. He is on the speaker’s panel for AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. Received research funding from AbbVie Canada, Amgen Canada, Pfizer Canada, Sandoz Canada. Alain Bitton has participated in advisory boards with AbbVie, Janssen, Takeda, McKesson, BioJamp, Bristol Myers Squibb Hoffman-LaRoche, Amgen. He has received research support from AbbVie. He is on the speaker’s panel for Janssen, Takeda, AbbVie and has participated in educational activities supported by Viatris, has received educational support from Fresenius Kabi, Amgen, and Takeda. Jennifer Jones has received honoraria for speaking and consulting for AbbVie, Janssen, Pfizer, Shire, and Takeda. She is the co-chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Gilaad Kaplan has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, and Takeda. He has received research support from Ferring, Janssen, AbbVie, GlaxoSmith Kline, Merck, and Shire. He has been a consultant for Gilead. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018. He is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Kate Lee has received honoraria from AbbVie Corporation and Bristol Myers Squibb Canada. Laura Targownik has received research funding from AbbVie Canada, Takeda Canada, Sandoz Canada, Amgen Canada, Gilead Canada, Roche Canada and Pfizer Canada, and has been on Advisory Boards for Janssen Canada, AbbVie Canada, Takeda Canada, Pfizer Canada, Merck Canada, Roche Canada, Sandoz Canada, Organon Canada, Fresesnius Kabi Canada, Eli Lilly Canada, and Amgen Canada. She is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Harminder Singh has been on advisory boards or consulted for Pendopharm, Amgen Canada, Roche Canada, Sandoz Canada, Takeda Canada, Bristol Myers Squibb, and Guardant Health Inc. and has received research funding for an investigator-initiated study from Pfizer. None: Joseph Windsor, Priscilla Matthews, Parul Tandon, Stephanie Coward, Juan-Nicolás Peña-Sánchez, Noelle Rohatinsky, Sara Ghandeharian, Saketh Meka, Roxana Chis, Sarang Gupta, Eric Cheah, Tal Davis, Jake Weinstein, James Im, Quinn Goddard, Julia Gorospe, Jennifer Loschiavo, Kaitlyn McQuaid, Joseph D’Addario, Ken Silver, & Robyn Oppenheim.

References

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The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD

Affiliations

The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD

Authors

Affiliations

Abstract

Conflict of interest statement

References

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