The Affordable Care Act at 5 Years.

n engl j med 373;16 nejm.org october 15, 2015 1579 iatrogenic radiation (repeated small-bowel imaging) imposes an environmental mutagenic pressure.3 In the past decade, there has been a major change in the management of Crohn’s disease through diagnosis by means of magnetic resonance enterography and treatment with powerful anti–tumor necrosis factor agents.4,5 Smallbowel cancer in Crohn’s disease may thus provide a natural test of the hypothesis of Luzzatto and Pandolfi: improved treatment of inflammation and reduction of mutagenic drivers may result in a reduction in the risk of smallbowel cancer to the level of risk imposed by chance alone.