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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Jens Kjeldsen, University of Southern Denmark, Odense
- Second opponent: Professor Laurent Peyrin-Biroulet, Nancy University Hospital, France
- Third member and chair of the evaluation committee: Associate Professor Anne-Marie Aas, University of Oslo
Chair of the Defence
Professor Emeritus Arild Nesbakken, University of Oslo
Principal Supervisor
Professor Milada Hagen, Oslo Metropolitan University
Summary
The IBSEN cohort included every patient diagnosed with inflammatory bowel disease (IBD) in South-Eastern Norway from 1990 to 1994. IBD consists of ulcerative colitis (UC) and Crohn’s disease (CD), it is a chronic, lifelong disease. Patients were invited to scheduled medical visits up to 20 years after diagnosis and underwent thorough clinical characterization. We exploited data from the Cancer Registry of Norway and the Causes of Death Registry, which include every Norwegian resident. Controls matched with patients were drawn from the general population. We used proportional hazard regression to assess the risk of cancer and mortality after 30 years of follow-up.
Patients with UC did not show a higher risk of mortality than control individuals. But we observed that patients with CD, specifically males, patients with elderly onset, patients with penetrating disease or colonic disease, had an increased risk of death than controls. Patients also had a higher risk of death due to cardiovascular disease.
Patients with UC were not at a higher risk of being diagnosed with cancer. However, they had a higher incidence of hematologic cancer than expected, and of biliary tract cancers in association with primary sclerosing cholangitis. Being prescribed thiopurines was associated with a higher risk of cancer. Patients with CD had an increased risk of overall cancer, in particular male patients. The findings of this register-based study are reassuring for IBD patients, with little difference in cancer and mortality risk compared to controls, most notably for colorectal cancer which has been known to be associated with longstanding IBD. However, there were subgroups of patients who had a higher risk of mortality, and specific cancer types were associated with medical treatment. Our findings highlight the importance of good clinical practices to prevent complications in longstanding, ageing patients with IBD.
Additional information
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