Gastroenterology

Gastroenterology

Volume 143, Issue 2, August 2012, Pages 390-399.e1
Gastroenterology

Original Research
Clinical—Alimentary Tract
Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

https://doi.org/10.1053/j.gastro.2012.05.004Get rights and content

Background & Aims

Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks.

Methods

We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers.

Results

In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09–1.53). Risk was greatest among individuals with Crohn's disease (IRR, 1.45; 95% CI, 1.13–1.85; adjusted HR, 1.28; 95% CI, 1.00–1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40–1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54–1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08–3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66–2.05).

Conclusions

Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.

Section snippets

Patients and Methods

We analyzed the inpatient and outpatient procedural and outpatient pharmaceutical insurance claims contained in the LifeLink Health Plan Claims Database (IMS Health, Norwalk, CT) for the period January 1, 1997, through December 31, 2009. The source database contains enrollment information on more than 60 million persons from more than 98 health plans across the United States. This longitudinal, patient-level database has also been used in previous epidemiologic studies of IBD.11, 18 The

Cohort Study

The cohort study population included 108,579 patients with IBD. Of these, 50,920 had CD, 56,390 had UC, and 1269 had IBD with unknown type. There were a total of 434,233 individuals in the non-IBD comparison cohort. The median length of follow-up within this cohort was 24 months (interquartile range, 12–43), with a range from 1 to 138 months. Length of follow-up was similar for CD (35 months; interquartile range, 21–52) and UC populations (37 months; interquartile range, 22–57) while

Discussion

Over the past 2 decades, there have been important advances in the therapy of IBD, including the addition of efficacious medications such as thiopurines and biologic anti-TNF agents to the therapeutic armamentarium. These medications have allowed for dramatic improvements in maintenance of clinical remission, endoscopic remission, and quality of life for patients with IBD. As these medications are used in increasing numbers for individuals with IBD, it becomes important to understand

Acknowledgments

The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information service(s): IMS LifeLink Health Plan Claims Database (1997–2009), IMS Health Incorporated. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary

References (42)

  • A. Ekbom et al.

    The epidemiology of inflammatory bowel disease: a large, population-based study in Sweden

    Gastroenterology

    (1991)
  • SEER stat fact sheets: melanoma of the skin

  • A. Jemal et al.

    Cancer statistics, 2010

    CA Cancer J Clin

    (2010)
  • H.W. Rogers et al.

    Incidence estimate of nonmelanoma skin cancer in the United States, 2006

    Arch Dermatol

    (2010)
  • B.A. Gilchrest et al.

    The pathogenesis of melanoma induced by ultraviolet radiation

    N Engl J Med

    (1999)
  • J.M. Elwood et al.

    Melanoma and sun exposure: an overview of published studies

    Int J Cancer

    (1997)
  • J.L. Bulliard et al.

    Latitude gradients in melanoma incidence and mortality in the non-Maori population of New Zealand

    Cancer Causes Control

    (1994)
  • V. Chaudru et al.

    Influence of genes, nevi, and sun sensitivity on melanoma risk in a family sample unselected by family history and in melanoma-prone families

    J Natl Cancer Inst

    (2004)
  • S. Euvrard et al.

    Skin cancers after organ transplantation

    N Engl J Med

    (2003)
  • D. Berg et al.

    Skin cancer in organ transplant recipients: Epidemiology, pathogenesis, and management

    J Am Acad Dermatol

    (2002)
  • L. Peyrin-Biroulet et al.

    Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease

    Gastroenterology

    (2011)
  • Cited by (422)

    • Health Care Maintenance in Pediatric Inflammatory Bowel Disease

      2023, Gastroenterology Clinics of North America
    • Safety Summary of Pediatric Inflammatory Bowel Disease Therapies

      2023, Gastroenterology Clinics of North America
    View all citing articles on Scopus

    This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this exam, successful learners will be able to interpret and communicate skin cancer risks in patients with inflammatory bowel disease (IBD).

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by a Career Development Award from the Crohn's and Colitis Foundation of America (M.D.L. and C.A.P.) and grants K08 DK088957-01 (to M.D.K.) and P30 DK034987 (to R.S.S.) from the National Institutes of Health.

    View full text