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Gut. Apr 2001; 48(4): 526–535.
PMCID: PMC1728259

The risk of colorectal cancer in ulcerative colitis: a meta-analysis


BACKGROUND AND AIMS—Controversy surrounds the risk of colorectal cancer (CRC) in ulcerative colitis (UC). Many studies have investigated this risk and reported widely varying rates.
METHODS—A literature search using Medline with the explosion of references identified 194 studies. Of these, 116 met our inclusion criteria from which the number of patients and cancers detected could be extracted. Overall pooled estimates, with 95% confidence intervals (CI), of cancer prevalence and incidence were obtained using a random effects model on either the log odds or log incidence scale, as appropriate.
RESULTS—The overall prevalence of CRC in any UC patient, based on 116 studies, was estimated to be 3.7% (95% CI 3.2-4.2%). Of the 116 studies, 41 reported colitis duration. From these the overall incidence rate was 3/1000 person years duration (pyd), (95% CI 2/1000 to 4/1000). The overall incidence rate for any child was 6/1000 pyd (95% CI 3/1000 to 13/1000). Of the 41 studies, 19 reported results stratified into 10 year intervals of disease duration. For the first 10 years the incidence rate was 2/1000 pyd (95% CI 1/1000 to 2/1000), for the second decade the incidence rate was estimated to be 7/1000 pyd (95% CI 4/1000 to 12/1000), and in the third decade the incidence rate was 12/1000 pyd (95% CI 7/1000 to 19/1000). These incidence rates corresponded to cumulative probabilities of 2% by 10 years, 8% by 20 years, and 18% by 30 years. The worldwide cancer incidence rates varied geographically, being 5/1000 pyd in the USA, 4/1000 pyd in the UK, and 2/1000 pyd in Scandinavia and other countries. Over time the cancer risk has increased since 1955 but this finding was not significant (p=0.8).
CONCLUSIONS—Using new meta-analysis techniques we determined the risk of CRC in UC by decade of disease and defined the risk in pancolitics and children. We found a non-significant increase in risk over time and estimated how risk varies with geography.

Keywords: ulcerative colitis; colorectal cancer; risk; meta-analysis

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Collins RH, Jr, Feldman M, Fordtran JS. Colon cancer, dysplasia, and surveillance in patients with ulcerative colitis. A critical review. N Engl J Med. 1987 Jun 25;316(26):1654–1658. [PubMed]
  • Gyde S. Screening for colorectal cancer in ulcerative colitis: dubious benefits and high costs. Gut. 1990 Oct;31(10):1089–1092. [PMC free article] [PubMed]
  • Sackett DL, Whelan G. Cancer risk in ulcerative colitis: scientific requirements for the study of prognosis. Gastroenterology. 1980 Jun;78(6):1632–1635. [PubMed]
  • Sackett DL. Bias in analytic research. J Chronic Dis. 1979;32(1-2):51–63. [PubMed]
  • Whelan G. Ulcerative colitis--what is the risk of developing colorectal cancer? Aust N Z J Med. 1991 Feb;21(1):71–77. [PubMed]
  • Choi PM, Zelig MP. Similarity of colorectal cancer in Crohn's disease and ulcerative colitis: implications for carcinogenesis and prevention. Gut. 1994 Jul;35(7):950–954. [PMC free article] [PubMed]
  • Gyde S, Prior P, Dew MJ, Saunders V, Waterhouse JA, Allan RN. Mortality in ulcerative colitis. Gastroenterology. 1982 Jul;83(1 Pt 1):36–43. [PubMed]
  • Hendriksen C, Kreiner S, Binder V. Long term prognosis in ulcerative colitis--based on results from a regional patient group from the county of Copenhagen. Gut. 1985 Feb;26(2):158–163. [PMC free article] [PubMed]
  • Kewenter J, Ahlman H, Hultén L. Cancer risk in extensive ulcerative colitis. Ann Surg. 1978 Dec;188(6):824–828. [PMC free article] [PubMed]
  • Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res. 1993;2(2):121–145. [PubMed]
  • Berkey CS, Hoaglin DC, Mosteller F, Colditz GA. A random-effects regression model for meta-analysis. Stat Med. 1995 Feb 28;14(4):395–411. [PubMed]
  • Persson PG, Bernell O, Leijonmarck CE, Farahmand BY, Hellers G, Ahlbom A. Survival and cause-specific mortality in inflammatory bowel disease: a population-based cohort study. Gastroenterology. 1996 May;110(5):1339–1345. [PubMed]
  • Bonnevie O, Riis P, Anthonisen P. An epidemiological study of ulcerative colitis in Copenhagen County. Scand J Gastroenterol. 1968;3(4):432–438. [PubMed]
  • MOSBECH J. Mortality from ulcerative colitis in Denmark. Gastroenterology. 1960 Dec;39:690–693. [PubMed]
  • SVARTZ N. The treatment of ulcerative colitis. Gastroenterology. 1954 Jan;26(1):26–passim. [PubMed]
  • Devroede GJ, Dockerty MB, Sauer WG, Jackman RJ, Stickler GB. Cancer of the colon in patients with ulcerative colitis since childhood. Can J Surg. 1972 Nov;15(6):369–374. [PubMed]
  • Hinton JM. Risk of malignant change in ulcerative colitis. Gut. 1966 Oct;7(5):427–432. [PMC free article] [PubMed]
  • SAUER WG, BARGEN JA. Chronic ulcerative colitis and carcinoma. J Am Med Assoc. 1949 Dec 3;141(14):982–illust. [PubMed]
  • SHANDS WC, DOCKERTY MB, BARGEN JA. Adenocarcinoma of the large intestine associated with chronic ulcerative colitis; clinical and pathologic features of 73 cases. Surg Gynecol Obstet. 1952 Mar;94(3):302–310. [PubMed]
  • Manning AP, Bulgim OR, Dixon MF, Axon AT. Screening by colonoscopy for colonic epithelial dysplasia in inflammatory bowel disease. Gut. 1987 Nov;28(11):1489–1494. [PMC free article] [PubMed]
  • BROOKE BN. Malignant change in ulcerative colitis. Dis Colon Rectum. 1961 Nov-Dec;4:393–398. [PubMed]
  • Poley JR. Chronic inflammatory bowel disease in children and adolescents: part II. South Med J. 1978 Sep;71(9):1123–1133. [PubMed]
  • Poley JR. Chronic inflammatory bowel disease in children and adolescents: part I. South Med J. 1978 Aug;71(8):935–948. [PubMed]
  • BARGEN JA, KENNEDY RL. Chronic ulcerative colitis in children. Postgrad Med. 1955 Feb;17(2):127–131. [PubMed]
  • Bonnevie O, Binder V, Anthonisen P, Riis P. The prognosis of ulcerative colitis. Scand J Gastroenterol. 1974;9(1):81–91. [PubMed]
  • Broström O, Löfberg R, Ost A, Reichard H. Cancer surveillance of patients with longstanding ulcerative colitis: a clinical, endoscopical, and histological study. Gut. 1986 Dec;27(12):1408–1413. [PMC free article] [PubMed]
  • Cave HW. Late Results in the Treatment of Ulcerative Colitis. Ann Surg. 1946 Oct;124(4):716–722. [PMC free article] [PubMed]
  • Choi PM, Nugent FW, Schoetz DJ, Jr, Silverman ML, Haggitt RC. Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis. Gastroenterology. 1993 Aug;105(2):418–424. [PubMed]
  • Fuson JA, Farmer RG, Hawk A, Sullivan BH. Endoscopic surveillance for cancer in chronic ulcerative colitis. Am J Gastroenterol. 1980 Feb;73(2):120–126. [PubMed]
  • Lennard-Jones JE, Morson BC, Ritchie JK, Williams CB. Cancer surveillance in ulcerative colitis. Experience over 15 years. Lancet. 1983 Jul 16;2(8342):149–152. [PubMed]
  • Lennard-Jones JE, Morson BC, Ritchie JK, Shove DC, Williams CB. Cancer in colitis: assessment of the individual risk by clinical and histological criteria. Gastroenterology. 1977 Dec;73(6):1280–1289. [PubMed]
  • Lennard-Jones JE, Misiewicz JJ, Parrish JA, Ritchie JK, Swarbrick ET, Williams CB. Prospective study of outpatients with extensive colitis. Lancet. 1974 Jun 1;1(7866):1065–1067. [PubMed]
  • MICHENER WM, GAGE RP, SAUER WG, STICKELER GB. The prognosis of chronic ulcerative colitis in children. N Engl J Med. 1961 Nov 30;265:1075–1079. [PubMed]
  • Nedbal J, Maratka Z. Ulcerative proctocolitis in Czechoslovakia. Am J Proctol. 1968 Apr;19(2):106–114. [PubMed]
  • Nugent FW, Haggitt RC, Gilpin PA. Cancer surveillance in ulcerative colitis. Gastroenterology. 1991 May;100(5 Pt 1):1241–1248. [PubMed]
  • Ritchie JK, Powell-Tuck J, Lennard-Jones JE. Clinical outcome of the first ten years of ulcerative colitis and proctitis. Lancet. 1978 May 27;1(8074):1140–1143. [PubMed]
  • Rutegård J, Ahsgren L, Stenling R, Janunger KG. Ulcerative colitis. Cancer surveillance in an unselected population. Scand J Gastroenterol. 1988 Mar;23(2):139–145. [PubMed]
  • Sedlack RE, Nobrega FT, Kurland LT, Sauer WG. Inflammatory colon disease in Rochester, Minnesota, 1935-1964. Gastroenterology. 1972 May;62(5):935–941. [PubMed]
  • Storgaard L, Bischoff N, Henriksen FW, Fischerman K, Jarnum S. Survival rate in Crohn's disease and ulcerative colitis. Scand J Gastroenterol. 1979;14(2):225–230. [PubMed]
  • HICKEY RC, TIDRICK RT. The catastrophic complications of ulcerative colitis: cancer, perforation and massive bleeding. J Iowa State Med Soc. 1956 Sep;46(9):485–492. [PubMed]
  • Ahsgren L, Jonsson B, Stenling R, Rutegård J. Prognosis after early onset of ulcerative colitis. A study from an unselected patient population. Hepatogastroenterology. 1993 Oct;40(5):467–470. [PubMed]
  • Aylett S. Cancer and ulcerative colitis. Br Med J. 1971 Apr 24;2(5755):203–205. [PMC free article] [PubMed]
  • Binder V, Bonnevie O, Gertz TC, Krasilnikoff PA, Vestermark S, Riis P. Ulcerative colitis in children. Treatment, course, and prognosis. Scand J Gastroenterol. 1973;8(2):161–167. [PubMed]
  • BROWN ML, KASICH AM, WEINGARTEN B. Complications of chronic ulcerative colitis. Am J Dig Dis. 1951 Feb;18(2):52–54. [PubMed]
  • CULLINAN ER, MACDOUGALL IP. The natural history of ulcerative colitis. Lancet. 1957 Mar 9;272(6967):487–489. [PubMed]
  • DAWSON IM, PRYSE-DAVIES J. The development of carcinoma of the large intestine in ulcerative colitis. Br J Surg. 1959 Sep;47:113–128. [PubMed]
  • DUKES CE, LOCKHART-MUMMERY HE. Practical points in the pathology and surgical treatment of ulcerative colitis: a critical review. Br J Surg. 1957 Jul;45(189):25–36. [PubMed]
  • EDLING NP, EKLOF O. Radiologic findings and prognosis in ulcerative colitis. Acta Chir Scand. 1961 May;121:299–308. [PubMed]
  • Fennessy JJ, Sparberg MB, Kirsner JB. Radiological findings in carcinoma of the colon complicating chronic ulcerative colitis. Gut. 1968 Aug;9(4):388–397. [PMC free article] [PubMed]
  • GOLDGRABER MB, HUMPHREYS EM, KIRSNER JB, PALMER WL. Carcinoma and ulcerative colitis, a clinical-pathologic study. II. Statistical analysis. Gastroenterology. 1958 May;34(5):840–846. [PubMed]
  • Greenstein AJ, Sachar DB, Smith H, Janowitz HD, Aufses AH., Jr A comparison of cancer risk in Crohn's disease and ulcerative colitis. Cancer. 1981 Dec 15;48(12):2742–2745. [PubMed]
  • Gyde SN, Prior P, Thompson H, Waterhouse JA, Allan RN. Survival of patients with colorectal cancer complicating ulcerative colitis. Gut. 1984 Mar;25(3):228–231. [PMC free article] [PubMed]
  • KIEFER ED, EYTINGE EJ, JOHNSON AC. Malignant degeneration in chronic ulcerative colitis. Gastroenterology. 1951 Sep;19(1):51–57. [PubMed]
  • KING RC, LINDNER AE, POLLARD HM. Chronic ulcerative colitis in childhood: a follow-up study. Arch Dis Child. 1959 Jun;34:257–261. [PMC free article] [PubMed]
  • LAHEY FH. The management of ulcerative colitis. Postgrad Med. 1950 Aug;8(2):93–100. [PubMed]
  • Lennard-Jones JE. The clinical outcome of ulcerative colitis depends on how much of the colonic mucosa is involved. Scand J Gastroenterol Suppl. 1983;88:48–53. [PubMed]
  • MACDOUGALL IP. Ulcerative colitis and carcinoma of the large intestine. Br Med J. 1954 Apr 10;1(4866):852–854. [PMC free article] [PubMed]
  • Michener WM, Farmer RG, Mortimer EA. Long-term prognosis of ulcerative colitis with onset in childhood or adolescence. J Clin Gastroenterol. 1979 Dec;1(4):301–305. [PubMed]
  • Rosenstock E, Farmer RG, Petras R, Sivak MV, Jr, Rankin GB, Sullivan BH. Surveillance for colonic carcinoma in ulcerative colitis. Gastroenterology. 1985 Dec;89(6):1342–1346. [PubMed]
  • Rutegård JN, Ahsgren LR, Janunger KG. Ulcerative colitis. Colorectal cancer risk in an unselected population. Ann Surg. 1988 Dec;208(6):721–724. [PMC free article] [PubMed]
  • Sugita A, Sachar DB, Bodian C, Ribeiro MB, Aufses AH, Jr, Greenstein AJ. Colorectal cancer in ulcerative colitis. Influence of anatomical extent and age at onset on colitis-cancer interval. Gut. 1991 Feb;32(2):167–169. [PMC free article] [PubMed]
  • Aktan H, Paykoç Z, Ertan A. Ulcerative colitis in Turkey: clinical review of sixty cases. Dis Colon Rectum. 1970 Jan-Feb;13(1):62–65. [PubMed]
  • Al-Nakib B, Radhakrishnan S, Jacob GS, Al-Liddawi H, Al-Ruwaih A. Inflammatory bowel disease in Kuwait. Am J Gastroenterol. 1984 Mar;79(3):191–194. [PubMed]
  • Albrechtsen D, Bergan A, Gjone E, Nygaard K, Flatmark A. Elective surgery for ulcerative colitis: colectomy in 158 patients. Scand J Gastroenterol. 1981;16(6):825–831. [PubMed]
  • BACON HE, CARROLL PT, CATES BA, MCGREGOR RA, OUYANG LM, VILLALBA G. Non-specific ulcerative colitis, with reference to mortality, morbidity, complications and long-term survivals following colectomy. Am J Surg. 1956 Nov;92(5):688–695. [PubMed]
  • Baker WN, Glass RE, Ritchie JK, Aylett SO. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis. Br J Surg. 1978 Dec;65(12):862–868. [PubMed]
  • BANKS BM, KORELITZ BI, ZETZEL L. The course of nonspecific ulcerative colitis: review of twenty years' experience and late results. Gastroenterology. 1957 Jun;32(6):983–1012. [PubMed]
  • BARGEN JA, GAGE RP. Carcinoma and ulcerative colitis: prognosis. Gastroenterology. 1960 Oct;39:385–393. [PubMed]
  • Biasco G, Brandi G, Paganelli GM, Rossini FP, Santucci R, Di Febo G, Miglioli M, Risio M, Morselli Labate AM, Barbara L. Colorectal cancer in patients with ulcerative colitis. A prospective cohort study in Italy. Cancer. 1995 Apr 15;75(8):2045–2050. [PubMed]
  • Blackstone MO, Riddell RH, Rogers BH, Levin B. Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. Gastroenterology. 1981 Feb;80(2):366–374. [PubMed]
  • Broström O, Löfberg R, Nordenvall B, Ost A, Hellers G. The risk of colorectal cancer in ulcerative colitis. An epidemiologic study. Scand J Gastroenterol. 1987 Dec;22(10):1193–1199. [PubMed]
  • BRUCE D, COLE WH. Complications of ulcerative colitis. Ann Surg. 1962 May;155:768–781. [PMC free article] [PubMed]
  • CARLESON R, FRISTEDT B, PHILIPSON J. Ulcerative colitis; a follow-up investigation of a 20-year primary material. Acta Med Scand. 1962 Dec;172:647–656. [PubMed]
  • Chuttani HK, Nigam SP, Sama SK, Dhanda PC, Gupta PS. Ulcerative colitis in the tropics. Br Med J. 1967 Oct 28;4(5573):204–207. [PMC free article] [PubMed]
  • COLCOCK BP, MATHIESEN WL. Complications of the surgical treatment of chronic ulcerative colitis. AMA Arch Surg. 1956 Mar;72(3):399–404. [PubMed]
  • Connell WR, Lennard-Jones JE, Williams CB, Talbot IC, Price AB, Wilkinson KH. Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis. Gastroenterology. 1994 Oct;107(4):934–944. [PubMed]
  • COUNSELL PB, DUKES CE. The association of chronic ulcerative colitis and carcinoma of the rectum and colon. Br J Surg. 1952 May;39(158):485–495. [PubMed]
  • De Dombal FT, Watts JM, Watkinson G, Goligher JC. Local complications of ulcerative colitis: stricture, pseudopolyposis, and carcinoma of colon and rectum. Br Med J. 1966 Jun 11;1(5501):1442–1447. [PMC free article] [PubMed]
  • DENNIS C, KARLSON KE. Surgical measures as supplements to the management of idiopathic ulcerative colitis; cancer, cirrhosis, and arthritis as frequent complications. Surgery. 1952 Nov;32(5):892–912. [PubMed]
  • Devroede GJ, Taylor WF, Sauer WG, Jackman RJ, Stickler GB. Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med. 1971 Jul 1;285(1):17–21. [PubMed]
  • Dickinson RJ, Dixon MF, Axon AT. Colonoscopy and the detection of dysplasia in patients with longstanding ulcerative colitis. Lancet. 1980 Sep 20;2(8195 Pt 1):620–622. [PubMed]
  • Dolcini H, Arabehety JT, Stapler NM. Ulcerative colitis. Follow-up of 100 patients, with some comments on the general features of this disease in Argentina. Am J Proctol. 1967 Apr;18(2):132–135. [PubMed]
  • Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. 1990 Nov 1;323(18):1228–1233. [PubMed]
  • Farmer RG, Hawk WA, Turnbull RB., Jr Carcinoma associated with mucosal ulcerative colitis, and with transmural colitis and enteritis (Crohn's disease). Cancer. 1971 Aug;28(2):289–292. [PubMed]
  • FLOOD CA, HIATT RB, KARUSH A, LEPORE MJ. Prognosis in chronic ulcerative colitis. J Chronic Dis. 1956 Sep;4(3):267–282. [PubMed]
  • Fung WP, Monteiro EH, Murugasu JJ, Ng KC, Kho KM, Lee SK. Non-specific ulcerative colitis in Chinese and Indians in Singapore. Med J Aust. 1971 Aug 14;2(7):361–365. [PubMed]
  • Gilat T, Fireman Z, Grossman A, Hacohen D, Kadish U, Ron E, Rozen P, Lilos P. Colorectal cancer in patients with ulcerative colitis. A population study in central Israel. Gastroenterology. 1988 Apr;94(4):870–877. [PubMed]
  • Gilat T, Zemishlany Z, Ribak J, Bennaroya Y, Lilos P. Ulcerative colitis in the Jewish population of Tel-Aviv Uafo. II: The rarity of malignant degeneration. Gastroenterology. 1974 Nov;67(5):933–938. [PubMed]
  • GLECKLER WJ, BROWN CH. Carcinoma of the colon complicating chronic ulcerative colitis. Gastroenterology. 1950 Apr;14(4):455–464. [PubMed]
  • Granqvist S, Gabrielsson N, Sundelin P, Thorgeirsson T. Precancerous lesions in the mucosa in ulcerative colitis. A radiographic, endoscopic, and histopathologic study. Scand J Gastroenterol. 1980;15(3):289–296. [PubMed]
  • Greenstein AJ, Sachar DB, Smith H, Pucillo A, Papatestas AE, Kreel I, Geller SA, Janowitz HD, Aufses AH., Jr Cancer in universal and left-sided ulcerative colitis: factors determining risk. Gastroenterology. 1979 Aug;77(2):290–294. [PubMed]
  • Grundfest SF, Fazio V, Weiss RA, Jagelman D, Lavery I, Weakley FL, Turnbull RB., Jr The risk of cancer following colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis. Ann Surg. 1981 Jan;193(1):9–14. [PMC free article] [PubMed]
  • Gyde SN, Prior P, Allan RN, Stevens A, Jewell DP, Truelove SC, Lofberg R, Brostrom O, Hellers G. Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres. Gut. 1988 Feb;29(2):206–217. [PMC free article] [PubMed]
  • HICKEY RC, TIDRICK RT. Cancer in patients with chronic ulcerative colitis. Cancer. 1958 Jan-Feb;11(1):35–39. [PubMed]
  • HIJMANS JC, ENZER NB. Ulcerative colitis in childhood. A study of 43 cases. Pediatrics. 1962 Mar;29:389–403. [PubMed]
  • HOLOWACH J, THURSTON DL. Chronic ulcerative colitis in childhood. J Pediatr. 1956 Mar;48(3):279–291. [PubMed]
  • Hughes RG, Hall TJ, Block GE, Levin B, Moossa AR. The prognosis of carcinoma of the colon and rectum complicating ulcerative colitis. Surg Gynecol Obstet. 1978 Jan;146(1):46–48. [PubMed]
  • HURT LE. The relationship of chronic ulcerative colitis to malignancy. Ann Surg. 1954 Jun;139(6):838–845. [PMC free article] [PubMed]
  • Johnson WR, McDermott FT, Hughes ES, Pihl EA, Milne BJ, Price AB. Carcinoma of the colon and rectum in inflammatory disease of the intestine. Surg Gynecol Obstet. 1983 Feb;156(2):193–197. [PubMed]
  • Jones HW, Grogono J, Hoare AM. Surveillance in ulcerative colitis: burdens and benefit. Gut. 1988 Mar;29(3):325–331. [PMC free article] [PubMed]
  • Jonsson B, Ahsgren L, Andersson LO, Stenling R, Rutegård J. Colorectal cancer surveillance in patients with ulcerative colitis. Br J Surg. 1994 May;81(5):689–691. [PubMed]
  • KAPEL O. Medical and modern surgical treatment of chronic ulcerative colitis. Acta Med Scand. 1950;138(5):328–340. [PubMed]
  • Katzka I, Brody RS, Morris E, Katz S. Assessment of colorectal cancer risk in patients with ulcerative colitis: experience from a private practice. Gastroenterology. 1983 Jul;85(1):22–29. [PubMed]
  • Kochhar R, Goenka MK, Kaushik SP, Gupta NM, Nagi B, Mehta SK. Colorectal carcinoma in Indian patients with idiopathic ulcerative colitis. Eur J Cancer Prev. 1992 Jun;1(4):293–296. [PubMed]
  • KORELITZ BI, GRIBETZ D, DANZIGER I. The prognosis of ulcerative colitis with onset in childhood. I. The presteroid era. Ann Intern Med. 1962 Oct;57:582–591. [PubMed]
  • KORELITZ BI, GRIBETZ D. The prognosis of ulcerative colitis with onset in childhood. II. The steroid era. Ann Intern Med. 1962 Oct;57:592–597. [PubMed]
  • Kusakcioglu O, Kusakcioglu A, Oz F. Idiopathic ulcerative colitis in Istanbul: clinical review of 204 cases. Dis Colon Rectum. 1979 Jul-Aug;22(5):350–355. [PubMed]
  • Kvist N, Jacobsen O, Kvist HK, Nørgaard P, Ockelmann HH, Schou G, Jarnum S. Malignancy in ulcerative colitis. Scand J Gastroenterol. 1989 May;24(4):497–506. [PubMed]
  • Lanfranchi GA, Brignola C, Michelini M, Campieri M, Bazzocchi G, Benatti A, Cortini C, Labó G, Parmeggiani A. Clinical course of ulcerative colitis in Italy. Digestion. 1980;20(2):106–110. [PubMed]
  • Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology. 1992 Nov;103(5):1444–1451. [PubMed]
  • Lashner BA, Provencher KS, Bozdech JM, Brzezinski A. Worsening risk for the development of dysplasia or cancer in patients with chronic ulcerative colitis. Am J Gastroenterol. 1995 Mar;90(3):377–380. [PubMed]
  • Lashner BA, Silverstein MD, Hanauer SB. Hazard rates for dysplasia and cancer in ulcerative colitis. Results from a surveillance program. Dig Dis Sci. 1989 Oct;34(10):1536–1541. [PubMed]
  • Leidenius M, Kellokumpu I, Husa A, Riihelä M, Sipponen P. Dysplasia and carcinoma in longstanding ulcerative colitis: an endoscopic and histological surveillance programme. Gut. 1991 Dec;32(12):1521–1525. [PMC free article] [PubMed]
  • Lennard-Jones JE, Melville DM, Morson BC, Ritchie JK, Williams CB. Precancer and cancer in extensive ulcerative colitis: findings among 401 patients over 22 years. Gut. 1990 Jul;31(7):800–806. [PMC free article] [PubMed]
  • LINDNER AE, KING RC, BOLT RJ. Chronic ulcerative colitis. A clinical appraisal and floow-up study. Gastroenterology. 1960 Aug;39:153–160. [PubMed]
  • Löfberg R, Broström O, Karlén P, Tribukait B, Ost A. Colonoscopic surveillance in long-standing total ulcerative colitis--a 15-year follow-up study. Gastroenterology. 1990 Oct;99(4):1021–1031. [PubMed]
  • LUMB G, PROTHEROE RH. Ulcerative colitis; a pathologic study of 152 surgical specimens. Gastroenterology. 1958 Mar;34(3):381–407. [PubMed]
  • Lynch DA, Lobo AJ, Sobala GM, Dixon MF, Axon AT. Failure of colonoscopic surveillance in ulcerative colitis. Gut. 1993 Aug;34(8):1075–1080. [PMC free article] [PubMed]
  • LYONS AS, GARLOCK JH. The relationship of chronic ulcerative colitis to carcinoma. Gastroenterology. 1951 Jun;18(2):170–178. [PubMed]
  • MACDOUGALL IP. THE CANCER RISK IN ULCERATIVE COLITIS. Lancet. 1964 Sep 26;2(7361):655–658. [PubMed]
  • MALTBY EJ, DICKSON RC, O'SULLIVAN PM. The use of ACTH and cortisone in idiopathic ulcerative colitis. Can Med Assoc J. 1956 Jan 1;74(1):4–9. [PMC free article] [PubMed]
  • Maratka Z, Nedbal J, Kociánová J, Havelka J, Kudrmann J, Hendl J. Incidence of colorectal cancer in proctocolitis: a retrospective study of 959 cases over 40 years. Gut. 1985 Jan;26(1):43–49. [PMC free article] [PubMed]
  • McMillan WO, Jr, Garbutt JT, Ruffin JM. Problem of cancer in ulcerative colitis. South Med J. 1968 May;61(5):526–528. [PubMed]
  • Mellemkjaer L, Olsen JH, Frisch M, Johansen C, Gridley G, McLaughlin JK. Cancer in patients with ulcerative colitis. Int J Cancer. 1995 Jan 27;60(3):330–333. [PubMed]
  • Micames C, Zaiter J, Nigaglioni A. Clínico-epidemiological features of 102 consecutive cases of ulcerative colitis in Puerto Rico. Bol Asoc Med P R. 1983 Mar;75(3):106–109. [PubMed]
  • Mir-Madjlessi SH, Farmer RG, Easley KA, Beck GJ. Colorectal and extracolonic malignancy in ulcerative colitis. Cancer. 1986 Oct 1;58(7):1569–1574. [PubMed]
  • Mir-Madjlessi SH, Forouzandeh B, Ghadimi R. Ulcerative colitis in Iran: a review of 112 cases. Am J Gastroenterol. 1985 Nov;80(11):862–866. [PubMed]
  • Moody GA, Jayanthi V, Probert CS, Mac Kay H, Mayberry JF. Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol. 1996 Dec;8(12):1179–1183. [PubMed]
  • NEFZGER MD, ACHESON ED. Ulcerative colitis in the United States Army in 1944. Follow-up with particular reference to mortality in cases and controls. Gut. 1963 Jun;4:183–192. [PMC free article] [PubMed]
  • Odes HS, Fraser D, Krawiec J. Ulcerative colitis in the Jewish population of southern Israel 1961-1985: epidemiological and clinical study. Gut. 1987 Dec;28(12):1630–1636. [PMC free article] [PubMed]
  • Patterson M, Castiglioni L, Sampson L. Chronic ulcerative colitis beginning in children and teenagers. A review of 43 patients. Am J Dig Dis. 1971 Apr;16(4):289–297. [PubMed]
  • Prior P, Gyde SN, Macartney JC, Thompson H, Waterhouse JA, Allan RN. Cancer morbidity in ulcerative colitis. Gut. 1982 Jun;23(6):490–497. [PMC free article] [PubMed]
  • Radhakrishnan S, Zubaidi G, Daniel M, Sachdev GK, Mohan AN. Ulcerative colitis in Oman. A prospective study of the incidence and disease pattern from 1987 to 1994. Digestion. 1997;58(3):266–270. [PubMed]
  • ROSENQVIST H, OHRLING H, LAGERCRANTZ R, EDLING N. Ulcerative colitis and carcinoma coli. Lancet. 1959 May 2;1(7079):906–908. [PubMed]
  • Rozen P, Baratz M, Fefer F, Gilat T. Low incidence of significant dysplasia in a successful endoscopic surveillance program of patients with ulcerative colitis. Gastroenterology. 1995 May;108(5):1361–1370. [PubMed]
  • RUSSELL IS, HUGHES ES. Carcinoma of the colon complicating ulcerative colitis. Aust N Z J Surg. 1961 May;30:306–311. [PubMed]
  • SCHLESINGER B, PLATT J. Ulcerative colitis in childhood and a follow-up study. Proc R Soc Med. 1958 Sep;51(9):733–735. [PMC free article] [PubMed]
  • SLANEY G, BROOKE BN. Cancer in ulcerative colitis. Lancet. 1959 Oct 31;2(7105):694–698. [PubMed]
  • Stewénius J, Adnerhill I, Anderson H, Ekelund GR, Florén CH, Fork FT, Janzon L, Lindström C, Ogren M. Incidence of colorectal cancer and all cause mortality in non-selected patients with ulcerative colitis and indeterminate colitis in Malmö, Sweden. Int J Colorectal Dis. 1995;10(2):117–122. [PubMed]
  • Stonnington CM, Phillips SF, Zinsmeister AR, Melton LJ., 3rd Prognosis of chronic ulcerative colitis in a community. Gut. 1987 Oct;28(10):1261–1266. [PMC free article] [PubMed]
  • STROMBECK JP. The surgical treatment of ulcerative colitis. Acta Chir Scand. 1949 Sep 3;98(3-6):414–pl. [PubMed]
  • Sugita A, Greenstein AJ, Ribeiro MB, Sachar DB, Bodian C, Panday AK, Szporn A, Pozner J, Heimann T, Palmer M, et al. Survival with colorectal cancer in ulcerative colitis. A study of 102 cases. Ann Surg. 1993 Aug;218(2):189–195. [PMC free article] [PubMed]
  • SVARTZ N, GILLNAS T. In which phase of ulcerative colitis does colonic cancer occur. Am J Dig Dis. 1958 Jul;3(7):537–548. [PubMed]
  • Tandon BN, Mathur AK, Mohapatra LN, Tandon HD, Wig KL. A study of the prevalence and clinical pattern of non-specific ulcerative colitis in northern India. Gut. 1965 Oct;6(5):448–453. [PMC free article] [PubMed]
  • THOMPSON JE. Ulcerative colitis. South Med J. 1961 Jul;54:801–807. [PubMed]
  • THORLAKSON RH. Carcinoma of the colon and rectum associated with chronic ulcerative colitis. Surg Gynecol Obstet. 1956 Jul;103(1):41–50. [PubMed]
  • Turunen MJ, Järvinen HJ. Cancer in ulcerative colitis: what failed in follow-up? Acta Chir Scand. 1985;151(8):669–673. [PubMed]
  • van Heerden JA, Beart RW., Jr Carcinoma of the colon and rectum complicating chronic ulcerative colitis. Dis Colon Rectum. 1980 Apr;23(3):155–159. [PubMed]
  • Vilien M, Jørgensen MJ, Ouyang Q, Schlichting P, Linde J, Riis P, Binder V. Colonic epithelial dysplasia or carcinoma in a regional group of patients with ulcerative colitis of more than 15 years duration. J Intern Med. 1991 Sep;230(3):259–263. [PubMed]
  • WARREN S, SOMMERS SC. Pathogenesis of ulcerative colitis. Am J Pathol. 1949 Jul;25(4):657–679. [PMC free article] [PubMed]
  • Watanabe H, Hiwatashi N, Yamagata S. Clinical observations on ulcerative colitis. Tohoku J Exp Med. 1977 Nov;123(3):197–213. [PubMed]
  • Waye JD. Dysplasia and ulcerative colitis--a colonoscopic study. Scand J Gastroenterol Suppl. 1983;88:44–47. [PubMed]
  • WECKESSER EC, CHINN AB. Carcinoma of the colon complicating chronic ulcerative colitis. J Am Med Assoc. 1953 Jul 4;152(10):905–908. [PubMed]
  • WHEELOCK FC, Jr, WARREN R. Ulcerative colitis; follow-up studies. N Engl J Med. 1955 Mar 17;252(11):421–425. [PubMed]
  • Woolrich AJ, DaSilva MD, Korelitz BI. Surveillance in the routine management of ulcerative colitis: the predictive value of low-grade dysplasia. Gastroenterology. 1992 Aug;103(2):431–438. [PubMed]
  • Yardley JH, Keren DF. "Precancer" lesions in ulcerative colits. A retrospective study of rectal biopsy and colectomy specimens. Cancer. 1974 Sep;34(3):suppl–suppl:844. [PubMed]
  • LAGERCRANTZ R. Follow-up investigation of children with ulcerative colitis; with special reference to indications for surgical therapy. Acta Paediatr. 1955 Jul;44(4):302–317. [PubMed]
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629–634. [PMC free article] [PubMed]
  • Butt JH, Lennard-Jones JE. A practical approach to the risk of cancer in inflammatory bowel disease. Med Clin North Am. 1980 Nov;64(6):1203–1220. [PubMed]
  • Whelan G. Cancer risk in ulcerative colitis: why are results in the literature so varied? Clin Gastroenterol. 1980 May;9(2):469–476. [PubMed]
  • Martins P, Soares C, Batista A. Proctocolite idiopática. Follow-up (1-13 anos) de 71 doentes. Acta Med Port. 1990 May-Jun;3(3):159–163. [PubMed]
  • Bansal P, Sonnenberg A. Risk factors of colorectal cancer in inflammatory bowel disease. Am J Gastroenterol. 1996 Jan;91(1):44–48. [PubMed]
  • Pinczowski D, Ekbom A, Baron J, Yuen J, Adami HO. Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study. Gastroenterology. 1994 Jul;107(1):117–120. [PubMed]
  • Eaden J, Abrams K, Ekbom A, Jackson E, Mayberry J. Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther. 2000 Feb;14(2):145–153. [PubMed]
  • Rosenberg L, Palmer JR, Zauber AG, Warshauer ME, Stolley PD, Shapiro S. A hypothesis: nonsteroidal anti-inflammatory drugs reduce the incidence of large-bowel cancer. J Natl Cancer Inst. 1991 Mar 6;83(5):355–358. [PubMed]

Figures and Tables

Figure 1
Incidence rate of colorectal cancer for any patient with ulcerative colitis, overall and by decade. Ca/pyd, cancer per person years duration.
Figure 2
Temporal relationship of colorectal cancer, overall and by geographical location.
Figure 3
Cumulative risk of developing colorectal cancer for any patient with ulcerative colitis based on stratified data (using stratified incidence, n=19).

Articles from Gut are provided here courtesy of BMJ Group


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