--- title: "Chemoprevention: risk reduction with medical therapy of IBD. | Sutter Health" description: "Chemoprevention is an area that holds great promise in the reduction of morbidity and mortality associated with IBD." url: "https://www.sutterhealth.org/research/publications/crc-risk-reduction-med-therapy-ibd-1055312878" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Chemoprevention: risk reduction with medical therapy of IBD. # Chemoprevention: risk reduction with medical therapy of inflammatory bowel disease. Chan EP & Lichtenstein GR. _Gastroenterol Clin North Am. 35(3):675-712._ 2006-09-01 ## Abstract The ideal chemopreventative agent, in addition to being efficacious in the prevention of cancer, must be easily administered, affordable, safe, and well tolerated, with minimal side effects. In the past decade, a growing body of literature has emerged on the prevention of CRC in patients with long-standing CD and UC. The data are not definitive and consist almost exclusively of retrospective case-control and cohort studies rather than the more rigorous prospective RCTs. 5-ASA compounds have been most thoroughly studied, and most of the existing data support the use of 5-ASA in the prevention of CRC. Although the precise dose and duration are unclear, studies suggest that chronic systemic administration of 5-ASA at a dose of at least 1.2 g/d is most likely to be effective. A beneficial effect of folate, albeit not statistically significant, has been consistently shown in every study performed for this purpose. Folate supplementation, which is safe and affordable, should also be recommended for all patients with IBD, especially those taking sulfasalazine. UDCA has been shown to exert a protective effect in most studies on patients with UC and concomitant PSC. Because this patient population is at particularly high risk for CRC, it is advisable to consider UDCA in all patients with colitis complicated by PSC. For patients without PSC, sufficient data do not exist to recommend it for the purpose of cancer prevention. Five of the six corticosteroid studies have found a beneficial effect of systemic steroids, although most did not reach statistical significance. Regardless, given the frequent and serious adverse effects associated with chronic steroid use, systemic corticosteroids should not be prescribed for this indication. Budesonide, an oral corticosteroid with minimal systemic absorption, is a potential alternative, although it has not yet been studied as a chemopreventative agent. Similarly, until the long-term safety of chronic NSAID use can be demonstrated in patients with IBD, the role of NSAIDs in chemoprevention remains undefined. Although the data are conflicting, immune-modulating medications, such as AZA, do not seem to confer any reduction in the risk of dysplasia or CRC. The data on calcium supplementation and statin use are still too limited to endorse their use for the prevention of colitis-related CRC. Chemoprevention is an area that holds great promise in the reduction of morbidity and mortality associated with IBD. Further studies, including prospective trials when possible and cost-effectiveness analyses, need to be performed to develop an optimal strategy for the reduction of cancer risk in patients with IBD. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/16952746) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Digestive Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Digestive+Disorders%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Conducting implementation research in community-based primary care: a qualitative study on integrating patient decision support interventions for cancer screening into routine practice.](https://www.sutterhealth.org/research/publications/integrate-cancer-screen-pt-decision-spt-1055312534) Frosch DL, Singer KJ, Timmermans S. Health Expect. 14 suppl 1:73-84. doi: 10.1111/j.1369-7625.2009.00579.x. 2011 Mar 01 - Publication ### [Potential hazards of submucosal injection of methylene blue.](https://www.sutterhealth.org/research/publications/hazards-submucosal-injection-methylene-blue-1055312987) Chan EP, Kaltenbach T, Rouse RV, Soetikno R. Am J Gastroenterol. 107(4):633-4. doi: 10.1038/ajg.2011.462. 2012 Apr 01 - Publication ### [In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings.](https://www.sutterhealth.org/research/publications/pt-consideration-multidisciplin-cancer-team-mtgs-1055312430) Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. PLoS One. 10(10):e0139921. doi: 10.1371/journal.pone.0139921. eCollection 2015. 2015 Oct 06 - Publication ### [Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening.](https://www.sutterhealth.org/research/publications/internet-pt-dec-spt-rct-prostate-cancer-screening-1055312532) Frosch DL, Bhatnagar V, Tally S, Hamori CJ, Kaplan RM. Arch Intern Med. 168(4):363-9. doi: 10.1001/archinternmed.2007.111. 2008 Feb 25 - Publication ### [Evolving goals of care discussions as described in interviews with individuals with advanced cancer and oncology and palliative care teams.](https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861) Dillon EC, Meehan A, Nasrallah C, Lai S, Colocci N, Luft H. Am J Hosp Palliat Care. 1049909120969202. doi: 10.1177/1049909120969202. Online ahead of print. 2020 Oct 28 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/crc-risk-reduction-med-therapy-ibd-1055312878#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Chemoprevention: risk reduction with medical therapy of IBD."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/crc-risk-reduction-med-therapy-ibd-1055312878#medicalscholarlyarticle","name":"Chemoprevention: risk reduction with medical therapy of inflammatory bowel disease.","headline":"Chemoprevention: risk reduction with medical therapy of IBD.","abstract":"The ideal chemopreventative agent, in addition to being efficacious in the prevention of cancer, must be easily administered, affordable, safe, and well tolerated, with minimal side effects. In the past decade, a growing body of literature has emerged on the prevention of CRC in patients with long-standing CD and UC. The data are not definitive and consist almost exclusively of retrospective case-control and cohort studies rather than the more rigorous prospective RCTs. 5-ASA compounds have been most thoroughly studied, and most of the existing data support the use of 5-ASA in the prevention of CRC. Although the precise dose and duration are unclear, studies suggest that chronic systemic administration of 5-ASA at a dose of at least 1.2 g/d is most likely to be effective. A beneficial effect of folate, albeit not statistically significant, has been consistently shown in every study performed for this purpose. Folate supplementation, which is safe and affordable, should also be recommended for all patients with IBD, especially those taking sulfasalazine. UDCA has been shown to exert a protective effect in most studies on patients with UC and concomitant PSC. Because this patient population is at particularly high risk for CRC, it is advisable to consider UDCA in all patients with colitis complicated by PSC. For patients without PSC, sufficient data do not exist to recommend it for the purpose of cancer prevention. Five of the six corticosteroid studies have found a beneficial effect of systemic steroids, although most did not reach statistical significance. Regardless, given the frequent and serious adverse effects associated with chronic steroid use, systemic corticosteroids should not be prescribed for this indication. Budesonide, an oral corticosteroid with minimal systemic absorption, is a potential alternative, although it has not yet been studied as a chemopreventative agent. Similarly, until the long-term safety of chronic NSAID use can be demonstrated in patients with IBD, the role of NSAIDs in chemoprevention remains undefined. Although the data are conflicting, immune-modulating medications, such as AZA, do not seem to confer any reduction in the risk of dysplasia or CRC. The data on calcium supplementation and statin use are still too limited to endorse their use for the prevention of colitis-related CRC. Chemoprevention is an area that holds great promise in the reduction of morbidity and mortality associated with IBD. 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