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is in favor of benefit at the population level. Risks seem to be focused in three main
groups: skin cancer, cervical dysplasia and/or cancer, and lymphoma. There may be
benefits of anti-TNF and other classes of medications that allow for mucosal healing
and therefore the reduction of colorectal dysplasia and cancer risk. A summary of
these risks is shown in Fig. 13.2. Additionally, in populations of patients with prior
malignancies, anti-TNF agents have not been associated with recurrence, when
carefully selected. As clinicians, we can offer various preventive measures to help
to prevent malignant complications in our patients. These efforts focus upon pri-
mary, secondary, and tertiary prevention of complications. Overall, a shared
decision- making process with appropriate follow-up, monitoring, and continued
discussions of risks and benefits of therapies will allow us to effectively and safely
treat our patients with IBD.

Anti-TNFs Immunomodulators Combined

Type of Cancer

NMSC^1

Melanoma

Lymphoma

HSTCL^2

Solid Tumors

Cervical Cancer

Colorectal Cancer ** *

(^1) Nonmelanoma Skin Cancer; (^2) Hepatosplenic T Cell Lymphoma
*Via a mechanism of inflammation reduction
= increased risk; = risk reduction; = no established risk modification.
Fig. 13.2 Cancer risk and reduction with anti-TNFs, immunomodulators, and combination
therapy
J.T. Hughes and M.D. Long