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Just published in the British Medical Journal: 

"Malignancy and mortality in people with coeliac disease: population based cohort study 

Joe West, Logan et al, Division of Epidemiology and Public Health, University of Nottingham, UK

Objective To quantify the risks of malignancy and mortality in people with coeliac disease compared with the general population. Participants 4732 people with coeliac disease and 23 620 matched controls. 

Results Of the 4732 people with coeliac disease, 134 (2.8%) had at least one malignancy and 237 (5.0%) died. The overall hazard ratios were: for any malignancy 1.29 (95% confidence interval 1.06 to 1.55), for mortality 1.31 (1.13 to 1.51), for gastrointestinal cancer 1.85 (1.22 to 2.81), for breast cancer 0.35 (0.17 to 0.72), for lung cancer 0.34 (0.13 to 0.95), and for lymphoproliferative disease 4.80 (2.71 to 8.50). The increased risk was primarily in the first year after diagnosis, with the risk for only lymphoproliferative disease remaining significantly raised thereafter. After excluding events in the year after diagnosis, the hazard ratio for malignancy was 1.10 (0.87 to 1.39) and for mortality was 1.17 (0.98 to 1.38), giving absolute excess rates of 6 and 17 per 10 000 person years, respectively. 

Conclusions People with coeliac disease have modest increases in overall risks of malignancy and mortality. Most of this excess risk occurs in the year of follow up after diagnosis. People with coeliac disease also have a noticeably reduced risk of breast cancer. The mechanism of this merits further attention as it may provide insights into the cause of this common malignancy."

Link: http://bmj.bmjjournals.com/cgi/reprint/329/7468/716



This excellent study supports some earlier findings about the reduced risk of breast cancer for coeliacs.  Some connection with agenerally lower BMI and/or absorbing less fat seems obvious.  Finding other factors (genetic?) would also be very interesting.  Do women with auto-immune disease in general have a different risk for breast cancer? 

I can't help thinking that, in the absense of general screening, diagnosed coeliacs are still over-represented by health conscious individuals, at least at present (and the lower incidence of smoking in the CD group would support this).  Looking at results from people with undetected CD would remove this possible bias ie what would be really useful would be to look at the rate of (diagnosed and undiagnosed) CD in people with breast cancer and see if there really were fewer coeliacs amongst them.

Charlotte

Oxford, UK

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