People with inflammatory bowel disease (IBD) who have precancerous colorectal lesions face a higher risk of developing colorectal cancer, according to new research led by NYU Langone Health. The study, published in Clinical Gastroenterology and Hepatology, analyzed data from more than 54,000 people with IBD in Sweden over nearly 15 years.
Researchers found that the risk of developing advanced dysplasia or colorectal cancer varies depending on the initial grade of precancerous lesions, known as dysplasia. Patients with low-grade dysplasia were found to be 3.5 times more likely to develop advanced conditions compared to those without such lesions. Among patients with high-grade dysplasia at the start of the study, 40 percent developed colorectal cancer during the follow-up period.
“While we have long known that dysplasia increases cancer risk in IBD, the exact level of danger for each grade has been unclear,” said lead author Jordan Axelrad, MD, MPH, associate professor in the Department of Medicine at NYU Grossman School of Medicine and co-director of NYU Langone’s Inflammatory Bowel Disease Center. “Our work provides robust, long-term data that can help doctors and patients make more informed decisions about the frequency of cancer screening and potential interventions.”
The team used pathology reports to categorize patients based on their initial findings: no dysplasia, indefinite dysplasia, low-grade dysplasia, or high-grade dysplasia. Statistical models were applied to determine each group’s likelihood of progressing to advanced lesions or cancer while accounting for factors such as age, sex, extent of IBD, and other medical conditions.
Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease—chronic illnesses affecting an estimated 3 million adults in the United States. Experts emphasize that regular colonoscopy screenings are important for early detection and removal of precancerous cells among these patients.
“Our next goal is to see if we can build a personalized risk calculator based on these findings,” said Dr. Axelrad. “Such a tool could help clinicians better tailor colonoscopy surveillance plans for each patient, potentially catching dangerous changes earlier while avoiding unnecessary procedures for those at lower risk.”
The research was conducted in collaboration with Karolinska Institutet and Örebro University. Funding was provided by organizations including the Crohn’s and Colitis Foundation and National Institutes of Health.
NYU Langone Health is recognized nationally for its focus on quality care across multiple locations and specialties.
