Risk of cancer is increased in patients with celiac disease

Patients with celiac disease have an increased risk of several malignancies, according to a report in the August 15th issue of the American Journal of Medicine.

Although European studies have found an increased risk of some cancers, particularly non-Hodgkin’s lymphoma, among patients with celiac disease, no US study has been carried out. Dr. Peter H. R. Green, of Columbia University, New York, and colleagues estimated the risk of malignancy in celiac disease patients compared with the general US population. In addition, they examined whether a gluten-free diet is protective.Three hundred eighty-one patients with celiac disease seen between 1981 and 2000 at a referral center were included in the study. The researchers used data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program to calculate standardized morbidity ratios (SMRs).Of the 381 celiac disease patients, 43 (11%) were diagnosed with cancer. Of these, 9 were after the diagnosis of celiac disease, 7 were within a month of diagnosis, and 27 were before the celiac disease diagnosis.The researchers report that the standardized morbidity ratio for all cancers was 1.5. Thirty-four malignancies were diagnosed before or within a month of celiac disease diagnosis, versus 14 expected (SMR = 2.4). Compared with expected rate, the team observed increased risks of small bowel cancer (SMR = 34), esophageal cancer (SMR = 12), non-Hodgkin’s lymphoma (SMR = 9.1), and melanoma (SMR = 5.0).”The most striking feature of our study is that the risk for non-Hodgkin’s lymphoma persisted despite diagnose and treatment with a gluten-free diet,” Dr. Green said in an interview with Reuters Health. The non-Hodgkin’s lymphoma included T-cell and B-cell types, and was found in gastrointestinal sites in five patients and extraintestinal sites in four patients.”The main implication [of these results] is that patients with [celiac disease] need to be followed closely after diagnosis,” Dr. Green explained. “In addition, it raises the possibility that despite the patients adhering to a strict gluten-free diet they may in fact be consuming gluten,” he noted. “This is because it may be very hard in the U.S. to be on a strict gluten-free diet [because] gluten is frequently present in processed food and in food that is prepared out of the home.”(Source: Am J Med 2003;115:191-195: Reuters Health: Michelle Chard: September 19, 2003: Oncolink)