Does monitoring prevent cancer in inflammatory bowel disease?

Surveillance colonoscopy for patients who have inflammatory bowel disease with colonic involvement has gained widespread acceptance. From an evidence-based perspective, however, the foundation for this practice remains weak. There are no randomized controlled trials, prospective cohort studies, or case-control studies that definitively prove a benefit for surveillance colonoscopy (i.e., reduction in colorectal cancer-related mortality). Nevertheless, circumstantial evidence indirectly suggests a benefit. This article reviews risk factors for colorectal cancer in inflammatory bowel disease and the evidence supporting the practice of colonoscopic surveillance. The benefits of frequent physician visits and compliance with medication regimens with regard to reduction in colorectal cancer risk are also reviewed.