People with inflammatory bowel disease (IBD) who have precancerous colorectal lesions face a significantly higher risk of developing colorectal cancer, according to a new study led by researchers at NYU Langone Health. The research found that the grade of dysplasia—abnormal cells in the colon that are not yet cancerous—plays a key role in determining this risk.
The study analyzed data from more than 54,000 individuals diagnosed with IBD using a national registry in Sweden. By following these patients for nearly 15 years, researchers were able to compare outcomes based on the initial grade of dysplasia: no dysplasia, indefinite dysplasia, low-grade dysplasia, and high-grade dysplasia.
Results showed that patients with low-grade precancerous lesions were 3.5 times more likely to develop advanced dysplasia or colorectal cancer compared to those without such lesions. Among those whose initial diagnosis was high-grade dysplasia, 40 percent developed colorectal cancer during the follow-up period. These findings clarify how different grades of precancerous changes affect future cancer risk.
Inflammatory bowel disease includes chronic conditions like ulcerative colitis and Crohn's disease, which cause long-term inflammation in the digestive tract. According to the Centers for Disease Control and Prevention, about 3 million adults in the United States are affected by IBD. The results highlight the importance for people living with IBD to follow their recommended colonoscopy schedules so doctors can detect and remove precancerous cells early.
Researchers used pathology reports to group patients by their initial level of dysplasia and employed statistical models that adjusted for other known risk factors such as age, sex, extent of IBD, and related medical conditions. This allowed them to isolate how much each grade of dysplasia contributed independently to cancer risk.
"Our next goal is to see if we can build a personalized risk calculator based on these findings," said Dr. Axelrad. "Such a tool could help clinicians better tailor colonoscopy surveillance plans for each patient, potentially catching dangerous changes earlier while avoiding unnecessary procedures for those at lower risk."
Adam Faye, MD, assistant professor in the Department of Medicine and director of clinical research at NYU Langone's IBD Center, also participated in the study along with collaborators from Karolinska Institutet and örebro University. Funding was provided by organizations including the Crohn's and Colitis Foundation and National Institutes of Health grants K23DK124570 and K76AG083286.
