title: Incidence of malignancies in diagnosed celiac patients: a population-based estimate.
abstract: OBJECTIVE
  The association between celiac disease and malignancies is well recognized. In Finland, the prevalence of clinically diagnosed adult celiac disease is 0.6%. In this large, population-based cohort, we aimed at a realistic projection of the cancer risk.
  
  
  METHODS
  In the period 2002-2011, the register comprised 32,439 adult celiac patients. This was linked with the Finnish Cancer Registry, which covers over 98% of diagnosed malignancies. The standardized incidence ratio (SIR) was calculated for the malignancies, on the basis of incidence figures for the whole population. A time-stratified analysis was made in celiac patients diagnosed after 2004 (n=11,991). Lifestyle factors, including smoking habits and obesity, were not obtainable.
  
  
  RESULTS
  The overall incidence ratio of malignant diseases was not increased (SIR 0.94; 95% confidence intervals 0.89-0.98), but it was ≥5 years from the diagnosis of celiac disease (1.31, 1.04-1.63). The SIRs for non-Hodgkin lymphoma (NHL; 1.94; 1.62-2.29), small-intestinal cancer (4.29; 2.83-6.24), colon cancer (1.35; 1.13-1.58), and basal cell carcinoma of the skin (1.13; 1.03-1.22) were increased, whereas those for lung cancer (0.60; 0.48-0.74), pancreatic cancer (0.73; 0.53-0.97), bladder cancer (0.53; 0.35-0.77), renal cancer (0.72; 0.51-0.99), and breast cancer (0.70; 0.62-0.79) were decreased. SIR for NHL immediately after the diagnosis of celiac disease was 2.56 (1.37-4.38).
  
  
  CONCLUSIONS
  There was no increased SIR of cancer in the whole series, but SIR was increased after 5 years from the diagnosis of celiac disease. The risk of breast and lung cancers was decreased. The risk of small-intestinal cancer and NHL was increased, but to a lesser extent than previously described.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
authors.forename: Tuire
authors.initials: T
authors.lastname: Ilus
authors.affiliation: 1] Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland [2] Department of Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.affiliation: Research Department, The Social Insurance Institution, Turku, Finland.
authors.forename: Lauri J
authors.initials: LJ
authors.lastname: Virta
authors.affiliation: 1] Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland [2] School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012042:Registries; D013997:Time Factors; D055815:Young Adult