Mortality and Cancer in Pediatric-Onset Inflammatory Bowel Disease: A Population-Based Study

OBJECTIVES: Although the incidence of pediatric inflammatory bowel disease (IBD) continues to rise in Northern France, the risks of death and cancer in this population have not been characterized. METHODS: All patients < 17 years, recorded in EPIMAD registry, and diagnosed between 1988 and 2004 with Crohn's disease (CD) or ulcerative colitis (UC) were included. The observed incidences of death and cancer were compared with those expected in the regional general population obtained by French Statistical Institute (INSEE) and the cancer Registry from Lille. Comparisons were performed using Fisher's exact test and were expressed using the standardized mortality ratios (SMRs) and standardized incidence ratios. RESULTS: A total of 698 patients (538 with CD and 160 with UC) were identified; 360 (52%) were men, the median age at IBD diagnosis was 14 years (12-16) and the median follow-up time was 11.5 years (7-15). During follow-up, the mortality rate was 0.84% (6/698) and did not differ from that in the reference population (SMR = 1.4 (0.5-3.0); P = 0.27). After a median follow-up of 15 years (10-17), 1.3% of patients (9/698) had a cancer: colon (n = 2), biliary tract (cholangiocarcinoma; n = 1), uterine cervix (n = 1), prepuce (n = 1), skin (basal cell carcinoma (n = 2), hematological (acute leukemia; n = 1), and small bowel carcinoid (n = 1). There was a significantly increased risk of cancer regardless of gender and age (standardized incidence ratio = 3.0 (1.3 -5.9); P < 0.02). Four out of nine patients who developed a cancer had received immunosuppressants or anti-tumor necrosis factor-alpha therapy (including combination therapy in three patients). CONCLUSIONS: In this large pediatric population-based IBD cohort, mortality did not differ from that of the general population but there was a significant threefold increased risk of neoplasia.