Perceived cancer risk from colitis-related dysplasia varies by clinician

(HealthDay)—Perceptions of cancer risk for colitis-associated dysplasia vary widely among clinicians, according to a study published in the January issue of the Journal of Crohn’s and Colitis.

Misha Kabir, M.B.B.S., from Imperial College London, and colleagues distributed a 15-item international online survey to 294 clinicians (gastroenterologists [93.5%] and colorectal surgeons) from 60 countries to examine understanding of cancer risk associated with dysplasia and management practices.

The researchers found that 23% of the respondents did not have access to high-definition chromoendoscopy. Compared with nonacademic workplaces, university hospitals were more likely to provide second expert histopathologist review (67 versus 46%) and formal multidisciplinary team meeting discussion (73 versus 52%) of dysplasia cases. There was variation from 0 to 100% observed in perceptions of five-year cancer risk associated with endoscopically unresectable low-grade dysplasia. Lower perceived cancer risks were predicted by nonacademic hospital affiliation.

Overall, 98.4 and 34.4% of respondents advised a colectomy for endoscopically unresectable visible high-grade dysplasia and unresectable visible low-grade dysplasia, respectively. Colectomy was more likely to be considered for multifocal low-grade dysplasia by respondents from university hospitals (odds ratio, 2.17). Continued surveillance was the preferred management over colectomy for clinicians working mainly in private clinics if invisible unifocal low-grade dysplasia was detected (odds ratio, 9.4) and was the least preferred management for those who had performed more than 50 surveillance colonoscopies (odds ratio, 0.41).

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