Gastroenterology

Gastroenterology

Volume 123, Issue 5, November 2002, Pages 1428-1435
Gastroenterology

Clinical–Alimentary Tract
Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis*

https://doi.org/10.1053/gast.2002.36585Get rights and content

Abstract

Background & Aims: Studies of cancer risk in celiac disease (CD) or dermatitis herpetiformis (DH) indicate increased risks for malignant lymphoma and occasionally other neoplasms, but are characterized by small numbers, lack of systematic cancer assessment, and subjects identified from referral institutions. Methods: By using Swedish population–based inpatient and cancer registry data, we followed-up 12,000 subjects with CD or DH, and evaluated cancer incidence by using standardized incidence ratios (SIR). Results: Adults (but not children and adolescents) with CD had an elevated overall risk for cancer (SIR = 1.3) that declined with time and eventually reached unity. Elevated risks were found for malignant lymphomas, small-intestinal, oropharyngeal, esophageal, large intestinal, hepatobiliary, and pancreatic carcinomas. The excess occurrence of malignant lymphomas was confined to adults, decreased with time of follow-up evaluation, and decreased over successive calendar periods. Decreased risks were found for breast cancer. Subjects with DH had a slightly increased overall cancer risk (SIR = 1.2) owing to excesses of malignant lymphoma and leukemia, but no increases of gastrointestinal carcinomas. Conclusions: Albeit increased, the relative risks for lymphomas and gastrointestinal cancers in this study are lower (and declining) than in most previous reports. The overall cancer risk is only moderately increased, and nonelevated during childhood and adolescence.

GASTROENTEROLOGY 2002;123:1428-1435

Section snippets

Patients

In Sweden, all inpatient care for CD during the study period was public and population based, and referral patterns were almost solely based on geographic (rather than financial or other) determinants. The inpatient register contains individual-based information on Swedish inpatient care on a countywide level since 1964, and nationwide since 1987.24 For each hospitalization, the inpatient registry includes the patient's national registration number, unique to each citizen,25 dates of admission

Celiac Disease

Two hundred and forty-nine cancers occurred among those discharged with CD (SIR = 1.3, 95% CI: 1.2–1.5, Table 2).The relative risk declined with increasing length of follow-up evaluation. After 10 or more years of follow-up evaluation, the SIR was only slightly and nonsignificantly elevated (SIR = 1.1, 95% CI: 0.9–1.4, Figure 1).

. Overall relative risk for cancer by time since first hospitalization for CD in a Swedish cohort of 11,019 individuals hospitalized with CD between 1964 and 1994.

Discussion

In this study, we showed that the overall cancer risk in a population-based cohort of individuals hospitalized with CD or DH over a 30-year period was only modestly elevated. In fact, in the first 5–10 years after initial hospitalization, no significant risk increase could be detected. Likewise, individuals first hospitalized as children or adolescents had no detectable increased cancer risk during their follow-up evaluation. Although we observed markedly elevated relative risks for malignant

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    *

    Address requests for reprints to: Johan Askling, M.D., Ph.D., Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute/Hospital, SE-171 76 Stockholm, Sweden. e-mail: [email protected].

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