Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn's disease or adenomas

Introduction

Adults with inflammatory bowel disease (IBD, which covers ulcerative colitis and Crohn's disease) or with adenomas have a higher risk of developing colorectal cancer than the general population. Colorectal cancer is the third most common cancer in the UK, with approximately 32,300 new cases diagnosed and 14,000 deaths in England and Wales each year. Around half of the people diagnosed with colorectal cancer survive for at least 5 years after diagnosis.

The prevalence of ulcerative colitis is approximately 100 to 200 per 100,000 and the annual incidence is 10 to 20 per 100,000. The risk of developing colorectal cancer for people with ulcerative colitis is estimated as 2% after 10 years, 8% after 20 years and 18% after 30 years of disease.

The prevalence of Crohn's disease is approximately 50 to 100 per 100,000 and the annual incidence is 5 to 10 per 100,000. The risk of developing colorectal cancer for people with Crohn's disease is considered to be similar to that for people with ulcerative colitis with the same extent of colonic involvement.

Colonoscopic surveillance in people with IBD or adenomas can detect any problems early and potentially prevent progression to colorectal cancer. For people who are not in these high-risk groups, the NHS Bowel Cancer Screening Programme offers screening using faecal occult blood testing every 2 years to all men and women aged 60 to 74 years. People undergoing colonoscopic surveillance are not generally offered screening as part of the Bowel Cancer Screening programme.

The British Society of Gastroenterology (BSG) issued guidelines for colonoscopic surveillance for people who have had adenomas removed and for people with IBD (Atkin and Saunders 2002; Eaden and Mayberry 2002; updated by Cairns et al. 2010). NICE has developed this short clinical guideline on the use of colonoscopic surveillance because of variations in clinical practice. Some members of the NICE Guideline Development Group (GDG) were also members of the group that developed the BSG guidelines. The evidence-based recommendations and algorithms developed in the NICE guideline are broadly consistent with those in the 2010 BSG guidelines. Both guidelines used a similar evidence base, with the exception of health economics evidence, which was not considered for the BSG guidelines. However, there are some differences between the two guidelines because the processes and methods used to develop each guideline were different.

Throughout this guideline, the term 'adenomas' is used. However, other terms have been used in the clinical studies included in the evidence review, for example 'polyps' or 'adenomatous polyps'.