Colorectal cancer still occurs more frequently in patients with ulcerative colitis, but is uncommon

In 2020, is there still an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC)? Surveillance is invasive, expensive and a burden for patients and historic studies of risk may be subject to lead-time or surveillance bias. This population-based Scandinavian study, with robust data collection and long follow-up, examined 96 000 UC patients to calculate both the relative risk of incident CRC but also CRC-related mortality. Mortality from CRC occurred in 0.55 per 1000 UC patient years, compared with 0.33 in the reference population (HR 1.59). The HR for CRC incidence was 1.66, being highest in those with disease onset before the age of forty, extensive UC, concomitant PSC or a family history of CRC. Interestingly the HR for CRC mortality decreased over time and was only 1.25 for the 2013–2017 cohort. No data on risk related to smoking, diet or the potential effects of drug therapy was available. The authors conclude that surveillance programmes need to improve, but an alternative interpretation …