title: A prospective cohort study of cancer incidence following the diagnosis of Parkinson's disease.
abstract: BACKGROUND
  Prior studies suggest a decreased risk of cancer among patients with Parkinson's disease (PD).
  
  
  METHODS
  Matched cohort analysis among the 22,071 participants in the Physician's Health Study. A total of 487 incident cases of PD without preceding cancer were identified by self-report. Each PD case was matched by age to a reference participant who was alive and cancer free at the time of PD diagnosis. Both cohorts were followed for incident cancer. We used proportional hazards models to calculate adjusted relative risks (RR) for cancer.
  
  
  RESULTS
  A total of 121 cancers were confirmed during a median follow-up of 5.2 years (PD) and 5.9 years (reference). Those with PD developed less cancer (11.0% versus 14.0%), with an adjusted RR of 0.85 [95% confidence interval (95% CI), 0.59-1.22]. Reduced risk was present for smoking-related cancers such as lung (RR, 0.32), colorectal (RR, 0.54), and bladder (RR, 0.68), as well as for most non-smoking-related cancers such as prostate cancer (RR, 0.74). In contrast, PD patients were at significantly increased risk (RR, 6.15; 95% CI, 1.77-21.37) for melanoma. PD patients who smoked were at reduced risk for smoking-related cancer (RR, 0.33; 95% CI, 0.12-0.92), whereas nonsmokers with PD were at increased risk (RR, 1.80; 95% CI, 0.60-5.39). This interaction was statistically significant (P(interaction) = 0.02).
  
  
  CONCLUSIONS
  Our results suggest a decreased incidence of most cancers in patients with PD. PD patients had a significantly increased risk of malignant melanoma, a finding consistent with prior studies. We confirmed an interaction between smoking and the relationship of PD to smoking-related cancer that may fit the pattern of a gene-environment interaction.
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Driver
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D010300:Parkinson Disease / Q000150:complications*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012907:Smoking / Q000009:adverse effects