<<Disclaimer: Verify this information before applying it to your situation.>> Kemp Randolph's comments are well taken, but I would like to add further comment using one of his statements as a starting point: >Still, the relative risk for getting a GI cancer from the >gluten in a normal diet seems to be 10- 100 times the normal rate for these >same cancers. (Based on the Holmes article and that Marsh chapter.) The reason I sent my previous communication and follow up with this one is because I feel that many celiac disease patients are likely to be scared out of their wits by statements such as: your risk is 100 times the normal rate. This statement is not incorrect, but it is possible to look at it from a different perspective. I suspect that the continual harping on cancer is driving people into irrational and compulsive behavior with regard to diet (my opinion of course--not proven fact). I strongly recommend a good solid gluten-free diet for celiac patients, but I don't think they should be terrified of looking at the facts and making an intelligent decision with regard to diet. As Kemp Randolph said, "Yes, if you eat less gluten, your risk will be less, but somewhere for each of us there'd be a point at which the extra effort in excluding more wouldn't seem worth it." With regard to cancer, let us just look at the coin from the other side--how many will not develop cancer. If I turn to the chapter by Holmes and Thompson (in the book Coeliac Disease, edited by Mike Marsh, Blackwell Scientific, 1992), I find in their Table 5.6 entitled "Cancer morbidity in CD by diet group" that for the 108 patients in the normal diet or reduced gluten diet group the number of all tumours was 2.6 times the expected number whereas for the gluten-free diet group, it was 1.5 times the expected number (the 1.5 was not considered significantly different from normal on a statistical basis). The actual numbers of tumours of all kinds (all sites) for the gluten-containing group was 14 for 108 subjects and the number for the gluten-free group was 17 out of 102, thus 13% vs. 17%. So despite the significant increase in cancer for the group that was eating gluten over the group that was not (except perhaps for the wheat starch as I discussed yesterday), one could conclude that the vast majority of celiac patients could pay no attention to diet whatsoever for their whole lives and still never develop cancer. In this same table, Holmes and Thompson indicate that the observed to expected ratio of lymphoma was 78 times greater for the gluten-eating group. Now we are getting close to that 100 times greater number. But the expected number was only 0.09 per 102 patients. Therefore, the 78 times greater number comes out to be 7.8 patients out of 100 (they actually observed 7 cases out of 102 patients studied for the gluten-eating group and observed 2 cases out of 108 patients in the gluten free group). Now, I do not in any way make light of these numbers. Obviously, they are of concern to anyone with celiac disease. However, I thought it might be a good idea for people to know a little bit more about where these numbers come from and what they mean. Sure hope I haven't made any mistakes. As before, corrections and criticism are welcome. In the end, each and every one of us is responsible for making arbitrary personal decisions about our behavior in regard to health, frequently with incomplete information. My goal is to try to make sure that you do have at least what information is available. Don Kasarda