title: All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: a Swedish population-based cohort study.
abstract: OBJECTIVE
  A reduced cancer risk amongst patients with multiple sclerosis (MS) has been reported. Theoretically, this could represent a genuine reduction in risk or, alternatively, 'diagnostic neglect', where cancer is undiagnosed when symptoms are misattributed to MS.
  
  
  OBJECTIVE
  Assess all-cause mortality risk following a cancer diagnosis in patients with MS compared with a cohort without MS.
  
  
  METHODS
  A cohort of MS patients (n = 19,364) and a cohort of the general population (n = 192,519) were extracted from national Swedish registers from 1969 to 2005. All-cause mortality after cancer in MS was compared with the general population. Poisson regression analysis was conducted in the MS and non-MS cohorts separately. The models were adjusted for follow-up duration, year at entry, sex, region and socioeconomic index. The two cohorts were combined and differences in mortality risk were assessed using interaction testing.
  
  
  RESULTS
  The adjusted relative risk (and 95% confidence interval) for all-cause mortality following a cancer diagnosis in MS patients (compared with MS patients without cancer) is 3.06 (2.86-3.27; n = 1768) and amongst those without MS 5.73 (5.62-5.85; n = 24,965). This lower magnitude mortality risk in the MS patients was confirmed by multiplicative interaction testing (P < 0.001).
  
  
  CONCLUSIONS
  A consistent pattern of lower magnitude of all-cause mortality risk following cancer in MS patients for a range of organ-specific cancer types was found. It suggests that cancer diagnoses tend not to be delayed in MS and diagnostic neglect is unlikely to account for the reduced cancer risk associated with MS. The lower magnitude cancer risk in MS may be due to disease-associated characteristics or exposures.
authors.affiliation: Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Neuroimmunology Unit, Department of Clinical Neuroscience and Centre for Molecular Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Roshanisefat
authors.affiliation: Clinical Epidemiology Unit and Centre for Pharmacoepidemiology, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.|Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Bahmanyar
authors.affiliation: Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Neuroimmunology Unit, Department of Clinical Neuroscience and Centre for Molecular Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Hillert
authors.affiliation: Neuroimmunology Unit, Department of Clinical Neuroscience and Centre for Molecular Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Olsson
authors.affiliation: Clinical Epidemiology Unit and Centre for Pharmacoepidemiology, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.|Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.|Research Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000401:mortality*; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Sweden; autoimmune; cancer; diagnostic neglect; epidemiology; immune-mediated; mortality; multiple sclerosis; survival