Cancer screening in inflammatory bowel disease

Bowel cancer is the third most common cancer in Britain, after breast cancer and prostate cancer. It has a high mortality rate, causing 14,000 deaths per year. Over 32,000 new cases of colorectal cancer are diagnosed every 12 months.

Unfortunately, many of the early symptoms of bowel cancer, such as a change in bowel habit, bloody stools and abdominal pain, are very similar to the symptoms of inflammatory bowel disease.

This means that there is an increased risk that these early warning signs can be missed and that treatment will not be started until the cancer is more advanced. With early treatment essential in colorectal cancer, this delay can have a significant effect on the outcome.

Inflammatory bowel disease and increased bowel cancer risk

Not only are you at risk of missing the early symptoms of bowel cancer if you have IBD, you are also at greater risk of developing the disease itself.

People with ulcerative colitis have a significantly increased risk of developing bowel cancer, and this risk increases the longer you have had the disease.

• 10 years after developing IBD, your cancer risk increases to 1/50
• 20 years after developing IBD, your cancer risk increases to 1/12
• 30 years after developing IBD, your cancer risk increases to 1/6

Add this to the increased risk of colorectal cancer that comes with advancing age and it is clear that cancer screening for IBD sufferers, particularly those with ulcerative colitis, is critical for the early detection and treatment of the disease.

Crohn’s disease does not have the same increased cancer risk as ulcerative colitis, however it can still mask many of the early symptoms, so leading to late detection.

NHS cancer screening in inflammatory bowel disease

NHS cancer screening has, in the past, been patchy across the England and Wales, with some areas offering excellent regular testing and others falling short. In an attempt to correct this, the National Institute for Clinical Excellence (NICE) recently issued guidelines on how often patients with IBD should be offered cancer screening colonoscopies.

Under the guidelines, patients deemed to be at low risk of developing colorectal cancer should be offered screening every five years, patients at medium risk should be offered screening every three years and patients at high risk should be offered screening every year.