My doctor told me that if you had dyplasia when your colon was removed you absolutely should have biopsies in the rectal cuff and pouch every year. I think the Cleveland Clinic study showed that 5% of cases ended up with rectal cuff cancer. These were mostly people who either had cancer or dyplasia when their colons were removed. I fall into a risk category, one because I had dysplasia with the colon, and two because I have had the pouch inflammation for 20 plus years. Another factor could be how much cuff your surgeon left in. My GI told me my surgeon left in a very small strip of rectal cuff and I imagine this was due to the extent of the disease.