Dr Chandni Radia
Research Training Fellowship to Predict Bowel Cancer Risk in People with PSC and Inflammatory Bowel Disease
Awarded to Dr Chandni Radia, King's College Hospital
The total grant awarded is £109,908
Duration of award: one year
Research title: Predicting bowel cancer risk in people with PSC and inflammatory bowel disease
Summary
PSC Support has awarded £109,908 to Dr Chandni Radia to assess how PSC impacts the risk of developing bowel cancer in PSC patients who also have IBD (inflammatory bowel disease), (“PSC-IBD” patients).
The findings from this research will be important in helping healthcare professionals decide how often people with PSC-IBD may need a colonoscopy.
A colonoscopy is a procedure where a camera is inserted into the bowel. In people with PSC-IBD, it is recommended this is done once a year to look for changes to the bowel, so that any cancer (or pre-cancerous changes) can be detected at an early stage when treatment is more likely to be successful.
What will Dr Chandni Radia and her team do?
Dr Radia and her team will use a specialist piece of software, and an expert in statistics, to analyse information from two sources:
- Existing data on a nationwide medical database which covers the medical history of more than 60 million patients. This will be used to compare how the rates of bowel cancer differ between PSC-IBD patients, and those with IBD alone, and how this has changed over time.
- New data collected from PSC-IBD patients in 10 UK hospitals, which will include findings from the colonoscopy reports, techniques used during the procedure, IBD treatment, and patient information (age/gender etc).
Dr Radia’s research will produce the largest PSC-IBD database created to date, from which she will be able to identify what makes someone with PSC-IBD more at risk of developing bowel cancer.
Dr Radia’s findings will produce guidance for doctors to assess how often each individual PSC-IBD patient should have a colonoscopy, based on their own risk factors.
Importantly, Dr Radia will then publicise the results of her research to medical professionals, PSC-IBD centres, and to patients. This way, it is expected that the research findings will lead to an improved standard of care for PSC-IBD patients.
Why is this study important?
This research seeks to address the gap in understanding of how the risk of bowel cancer is different in IBD patients with PSC and those without. The results will provide doctors with important information which should allow them to assess a PSC-IBD patient’s risk of developing bowel cancer on a more individual basis, and therefore safely tailor the colonoscopy schedule to their own needs.
It is no secret that colonoscopies can be unpleasant, uncomfortable and cause anxiety for patients. This may explain why as many as 40% of PSC-IBD patients do not have their procedure undertaken once a year as recommended, as well as long NHS waiting lists.
It will be a welcome relief for those PSC-IBD patients who are identified at lower risk and can safely reduce the frequency of their colonoscopies. For those at a higher risk, it will reinforce the importance of this regular screening procedure.
Progress Report
"People with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD) are known to have an increased risk of bowel cancer. Historical research suggests this risk is anywhere from 3 to 10 times higher than the risk in patients with IBD only. As a result, doctors advise a yearly camera test of the colon (colonoscopy surveillance) to look for cancer or pre-cancerous change.
A lot of research has shown that specific risk factors can impact bowel cancer risk in IBD. The new guidelines for doctors on colonoscopy surveillance allow the frequency of these procedures to be tailored to each patient’s individual risk factors. However, as PSC-IBD is so rare, the same research has been difficult to undertake in this group.
I have now gathered data from seven hospitals in the UK including a total of over 600 patients with PSC-IBD to identify:
- Factors that improve the quality of colonoscopy surveillance
- The current risk of bowel cancer in patients with PSC-IBD
- Factors that differentiate individuals with higher or lower risk or cancer
On reviewing over 3,500 records of colonoscopy procedures, analysis has shown that chromoendoscopy (a technique to enhance the endoscopy image) with virtual electronic techniques may be equally as effective as a dye-spray technique at recognising pre-cancerous changes in the bowel. Though this is not yet part of the IBD surveillance guidelines, it adds to the evidence available for future guideline changes.
Further analysis of the data has so far shown that the 10-year risk of bowel cancer may be as low as 1.8% at 10 years and 4% at 20 years. This is lower than previous studies. This will now be compared to a national GP database with higher patient numbers to ensure we are not under- or over-estimating the risk.
Finally, analysis of the data has identified potential factors related to bowel cancer risk. Patients with poorly controlled inflammation in the colon for consecutive years and more medication changes (specifically advanced therapies with biologics and small molecules) seem to have a higher risk. Patients with pre-cancerous changes are also more likely to have further pre-cancerous changes or bowel cancer in the future. These are both similar to patients with IBD only. Further analysis is underway to find factors that reduce the likelihood of bowel cancer. These findings will help inform future surveillance guidelines and improve care for people with PSC-IBD."
Dr Chandni Radia, November 2025
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