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Marie L. Borum, Harjiwander Preethi Sidhu, Leigh Bornstein, Physicians may inadequately counsel inflammatory bowel disease patients about immunosuppressive therapy and risk of nonmelanoma skin cancer, Inflammatory Bowel Diseases, Volume 17, Issue 5, 1 May 2011, Page 1246, https://doi.org/10.1002/ibd.20979
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To the Editor:
We read with interest the article published by Maddow and Soltani1 that described an increased risk of azathioprine use and nonmelanoma skin cancer. It offered important information about immunosuppressive therapy in individuals with inflammatory bowel disease (IBD). While recent studies have reported an increase in the incidence of nonmelanoma skin cancer in patients maintained on immunosuppressive therapy,1,2 it is uncertain if physicians adequately counsel IBD patients about this risk. We evaluated physicians' counseling of IBD patients about immunosuppressants and the potential risk of skin cancer with the use of 6-mercaptopurine and azathioprine.
The medical records of 204 consecutive IBD patients seen in a gastroenterology practice in a 1-year period at an urban university were reviewed. There were 124 women and 80 men (mean age 40 years). Sixty patients were maintained on immunosuppressive therapy with 6-mercaptopurine or azathioprine. Twenty-one of 60 (35%) patients on immunosuppressive therapy received counseling regarding potential bone marrow toxicity. None of the 60 (0%) patients were counseled about the potential increased risk of nonmelanoma skin cancer. There was a significant difference (P < 0.0001) in the rate at which patients maintained on immunosuppressant were counseled about bone marrow toxicity compared to nonmelanoma skin cancer.
