Celiac.com 05/13/2009 - People with silent celiac disease, those who test positive for celiac disease antibodies, yet show no clinical signs of the disease itself, do not face a higher risk for developing malignant cancers, according to results of a recent Finnish study.
Previous studies done in the 1970s and 1980s indicated that patients with clinically recognized celiac disease face a higher risk for developing malignancies, Dr. Katri Kaukinen, of the University of Tampere, Finland, told reporters from Reuters Health. However, she explained, "it has not been known whether apparently clinically silent unrecognized cases also carry an increased risk of celiac disease-related complications, and thus whether the healthcare system should recognize and treat."
In an effort to answer that question, Dr. Kaukinen led team of researchers in assessing whether adults with previously unrecognized screening-identified evidence of celiac disease have an increased risk of malignancies.
Recent screening figures put the prevalence of celiac disease somewhere between 1% and 2% of the population, which means from 7 to 14 million Europeans with gluten intolerance. 75% to 90% of all the celiac disease remains undiagnosed due to absent or atypical symptoms.
The team examined data from a Finnish population-based adult-representative cohort of 8000 subjects compiled from 1978 to 1980. In 2001, the researchers screened blood samples of people with no history of celiac disease or any malignancy (n = 6849) for immunoglobulin A (IgA) class tissue transglutaminase antibodies. They further screened
positive samples for IgA class tissue transglutaminase antibodies (Celikey tTG) and for IgA endomysial antibodies (EMA).
The team analyzed a total of 6849 blood samples. 565 samples showed positive Eu-tTG results. 202 of these subjects showed positive Celikey tTG results ((2.9%) while 73 showed positive EMA screens (1.1%).
Just over 10% of the study subjects, a total of 694 participants, developed malignancies during the period of the study. Overall malignancy risk was no higher for celiac autoantibody-positive subjects. Adjusted for age and sex, the results showed that the relative risks were 0.91 for those who were Celikey tTG positive, and 0.67 and for those who were EMA positive.
According to Dr. Kaukinen, the results seem to support the current clinical approach, and suggests that "earlier diagnosis of the disease through serological mass screening would not be beneficial in improving the prognosis of celiac disease as regards malignancies."
However, before completely ruling out mass screening, Dr Kaukinen noted that it is important to pursue "further prognostic studies [on] mortality and fractures among earlier unrecognized celiac disease cases," as "[t]hese issues should be also addressed" before any official decisions are made regarding the use of mass blood screening for celiac disease.Gut 2009; 58:643-647