New Genetic Test Predicts Colorectal Cancer Risk in IBD Patients

New Test Could Predict Which IBD Patients Are at Higher Risk for Colorectal Cancer

Inflammatory bowel disease (IBD), encompassing conditions such as ulcerative colitis and Crohn’s disease, is associated with an increased risk of developing colorectal cancer (CRC), or bowel cancer. This increased risk is linked to the chronic inflammation caused by IBD, which can lead to abnormal cellular changes and precancerous growths in the intestines. Current screening methods, primarily colonoscopies, are used to monitor these patients regularly for early signs of cancer, but identifying precancerous cells in IBD patients remains a difficult task. However, new research from the Institute of Cancer Research (ICR) in London has introduced a groundbreaking test that promises to predict which IBD patients are at higher risk for developing colorectal cancer with over 90% accuracy.

The Challenge of Colorectal Cancer in IBD Patients

It is well-established that individuals with IBD face a significantly higher risk of colorectal cancer. Chronic inflammation, particularly in cases of ulcerative colitis and Crohn's disease, can result in the development of dysplasia—abnormal cell growth—which is a precursor to cancer. These changes in cellular structure are often difficult to detect through conventional means, particularly when the disease has caused widespread inflammation. As a result, IBD patients are typically monitored for signs of colorectal cancer via regular colonoscopies, usually every one to three years. However, past research has highlighted the challenges in detecting early pre-cancerous cells in IBD patients, especially since these cells are often surrounded by inflammation, making identification tricky.

The New Test Developed by the Institute of Cancer Research

Researchers at the Institute of Cancer Research, led by Professor Trevor Graham, have developed a promising new genetic test that they claim can predict the risk of colorectal cancer in IBD patients with remarkable accuracy. The test focuses on identifying changes in the DNA of pre-cancerous cells that are common among patients with IBD. These genetic alterations, such as the loss or gain of multiple copies of certain genes, are linked to an increased risk of cancer.

Dr. Graham, who is a professor of genomics and evolution and director of the Centre for Evolution and Cancer at the Institute of Cancer Research, explained that although it is well-known that people with IBD are at greater risk for colorectal cancer, predicting who will actually develop cancer has been a major challenge. Currently, the only effective treatment for those deemed at imminent risk of cancer is surgery, which involves removing part or all of the large bowel. However, determining which patients need surgery is not always straightforward, leading to unnecessary procedures for some patients and prolonged anxiety for others who are at lower risk.

How the New Test Works

The test developed by Graham and his team is a genetic test that analyzes biopsy samples taken during colonoscopy procedures. When a doctor identifies unusual cells during a colonoscopy, a biopsy is performed to take a small tissue sample for analysis. Traditionally, these biopsies are examined for signs of dysplasia or other abnormalities, but the new test goes further by analyzing the genetic signals within the biopsy samples. Specifically, it looks for patterns of genetic changes in pre-cancerous cells that indicate a higher risk of cancer.

By comparing the genetic signatures from patients who developed cancer with those who did not, the researchers created an algorithm that can predict the likelihood of developing colorectal cancer within five years. The test focuses on detecting DNA alterations that are specific to people with IBD who go on to develop cancer. According to the researchers, this predictive model has been shown to be over 90% accurate in identifying which patients are at the highest risk for developing colorectal cancer.

Study Reference: https://gut.bmj.com/content/early/2025/01/29/gutjnl-2024-333353

A Step Toward More Accurate and Targeted Treatment

The potential of this test is enormous. For patients identified as being at high risk for cancer, the test could prompt more aggressive interventions, such as early surgery to remove part of the bowel before cancer develops. On the other hand, patients who are identified as being at low risk could avoid unnecessary treatments, such as repeat colonoscopies or even major surgical procedures.

For IBD patients, this test could mean a more personalized approach to care, where treatment decisions are based on accurate predictions rather than generalized risk factors. For example, those at high risk may opt for surgery, while those at low risk may continue with less invasive options, thus reducing both physical and emotional strain. The key advantage of this test is its ability to accurately assess the risk of colorectal cancer based on genetic changes in pre-cancerous cells, rather than solely relying on subjective biopsies.

Clinical Trials and the Future of Predictive Testing

While the new test has shown impressive results in the laboratory, the next step is to validate these findings in larger, diverse clinical trials. If these trials confirm the results, this test could be adopted into clinical practice, offering a non-invasive and highly accurate method to predict cancer risk in IBD patients. Professor Graham and his team are optimistic that the test could eventually be made available through the National Health Service (NHS) and other health systems, improving the way IBD patients are monitored for colorectal cancer risk.

One of the exciting aspects of the test is its potential to move beyond colonoscopies and biopsies. Currently, colonoscopies are the gold standard for detecting precancerous changes in IBD patients, but they are invasive and not always effective at identifying early cancer signs. If the genetic test can be adapted into a blood or stool test, it could dramatically simplify and improve the process for screening IBD patients. A less invasive approach to monitoring cancer risk would not only improve patient compliance but also reduce healthcare costs and the emotional burden of frequent invasive procedures.

The Impact on Gastroenterologists and IBD Management

For gastroenterologists, this test could become a valuable tool in managing IBD patients at risk for colorectal cancer. As Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center, mentioned, the study represents a major step forward in accurately identifying patients at higher risk for colorectal cancer. He emphasized that it could alleviate the challenging decisions gastroenterologists face regarding whether to recommend surgery or continue with more frequent surveillance. Having a test with 90% accuracy would simplify decision-making and lead to more targeted treatment strategies.

Dr. Nilesh Vora, a hematologist and oncologist, also praised the study for its potential to accurately identify high-risk patients. He sees this new test as a major breakthrough in colorectal cancer prevention for IBD patients and believes it could help determine which patients need more frequent colonoscopies and which can safely space out their screenings.

Conclusion: A Promising Development for IBD Patients

The development of a genetic test that can predict the risk of colorectal cancer in IBD patients is a promising advancement in both oncology and gastroenterology. With over 90% accuracy, this test could significantly improve the ability to identify high-risk patients and reduce unnecessary procedures, ultimately leading to better-targeted treatments and improved outcomes. While more research is needed, this test holds the potential to revolutionize how IBD patients are managed and offers hope for a more personalized and less invasive approach to cancer screening in this high-risk population.

 

I am interested to know more about this test/.
Kindly let me know, where is this test available in Canada ??