Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis.
OBJECTIVE
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.
Askling
Johan
J
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute/Hospital, Stockholm, Sweden. johan.askling@medks.ki.se
Linet
Martha
M
Gridley
Gloria
G
Halstensen
Trond S
TS
Ekström
Karin
K
Ekbom
Anders
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003874:Dermatitis Herpetiformis / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D018570:Risk Assessment; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology