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).

"This study highlights the need for further education and uptake of guideline recommendations," the authors write.

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