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Colon cancer in IBD: What’s all the fuss about? part 6/6

– Great, great, so the question is what about Vitamin D, calcium. No one’s looked at that in IBD. I think it would be very
important to look at. I think it’s becoming
increasingly important in sporadic colon cancer and one of the important
chemopreventive agents for sure. You know, it would be tough I
think in a retrospective way. A lot of people take multivitamins and it’d be hard to control for. And if you go back and do
these retrospective studies, nobody writes down in their notes whether the person is
on Vitamin D or calcium so I think it would be hard to do. But I think in a prospective
way it would be very important. The microbiome is fascinating. I mean, I think that
no one’s looking at it yet in this setting but people are clearly
looking at the microbiome in terms of causing
colitis in the first place. And it might be intriguing if there is a different progression, left side versus right side. Is the ecology, the microflora, different in the left versus the right? I think that’s a very
tantalizing hypothesis but it needs some data, Dean. – Does anybody see
aberrant crypt foci in IBD? – The question is, is there
aberrant crypt foci in IBD? I don’t think anybody calls
them aberrant crypt foci in IBD but I’m not aware. Henry, maybe you can answer that. I don’t see that in a colectomy specimen where you have the whole thing rolled out. – You don’t know it. (loud laughing) – Don’t ask–
– I’ve got too many ethics. – Yeah, I don’t think people
have really reported that. Henry, yes, go ahead. – See, you put down a lot
of data about progression based on a number of different studies and the studies are
probably not comparable in terms of protocol sampling. – Absolutely. – What is the impact of
sampling on progression? – Well, you know, that’s why
Peter did the modeling study, is because most of the time we’re taking 20 biopsies or less. What is interesting is
you’re absolutely right. In some of these studies there might have been 10 biopsies
done but it’s interesting. If you think about it, even though we’ve been doing a
suboptimal number of biopsies are we causing any harm? When you think about it, the dysplasia rates seem to be going down. I mean, if we were really
missing a lot of things because we weren’t taking enough biopsies, we probably would see it. We would see more breakthrough cancers. We would see more breakthrough
high-grade dysplasias. We’re not seeing that. Most centers that I’m
aware of are not seeing these sort of breakthrough cancers. So even though it’s nice to say you should be doing 30, 40 biopsies, no one does it and I think frankly it ain’t all that harmful. And I think Peter’s study was important because it says that the reason you may not find it with so few biopsies is because the field effect may not be as large as we thought. The field has to be larger, the dysplasia field in
the colon has to be larger to be able to pick it up
with some random biopsies. – Maybe some of these progression data, had more biopsies been taken, may not have been progression but it would have been
incident dysplasia instead. – Yeah, correct, you’re absolutely right and everybody does things differently but, I mean, I think
this is the failing of… You know, that’s why I put
in that Winston Churchill’s. You know, it’s not the greatest data but it’s the best that we have, yes. – Many of these progression studies, they plot the data based
on the kind of diagnosis. I just wanted to (mumbles)
control duration of disease. Do people look at this in
terms of duration of symptoms? (mumbles) – Yeah, I think maybe the
question you’re getting at is can you start the clock from the age of onset of colitis, right? Because if I’m interpreting this right, you’re finding dysplasia
at a certain point in time but how do you know there wasn’t
dysplasia before that or… And the age of onset of colitis, so you have the duration
of disease in that sense, some studies say that younger age is a higher risk of getting cancer. The problem with that
is the younger you are, usually the more years of colitis you’ve had to get your cancer. So if you separate out disease duration from age of onset usually that drops out. So we don’t believe that age of onset by itself is a risk factor. It’s the duration of colitis, with all of the failings of understanding what that really is. When did colitis begin? Somebody who has three years
of intermittent diarrhea maybe even with blood but
didn’t get a colonoscopy, do you time it from
their first colonoscopy or do you time it from the
very first bloody stool? And studies have done things differently so we don’t really know. I mean, disease duration is a
little bit of a moving target. Thank you. (crowd applauds)

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