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  • Scott Adams
    Scott Adams

    Celiac Disease Malignancy Risk Higher Despite Gluten-free Diet

    Reviewed and edited by a celiac disease expert.

    Am J Med. 2003 Aug 15;115(3):191-5

    Celiac.com 09/03/2003 - The results of a study conducted by Dr. Peter Green and colleagues at the College of Physicians and Surgeons in New York City indicate that, despite a gluten-free diet, people with celiac disease still have an elevated risk of getting non-Hodgkins lymphoma. The good news is that the risk of getting other types of cancers like small intestinal adenocarcinoma, esophageal cancer and melanoma were reduced in patients who adhered to a gluten-free diet, as was the overall risk of getting non-Hodgkins lymphoma. The study looked at 381 celiac disease patients, out of which 43 were diagnosed with cancer (11%). The vast majority—34—were diagnosed at or before their celiac disease diagnoses, so it is safe to say that they were not following a gluten-free diet.

    The results of this study emphasize the importance of adhering to a strict gluten-free diet, and of getting regular checkups by your doctor. Cancer screenings may also be advised, especially in cases where unexplained symptoms continue after going gluten-free. There is currently, however, no specific test for non-Hodgkins lymphoma, so one must learn about its warning signs and be on the lookout for any symptoms. - Scott Adams

    Here is the abstract of the study:

    Risk of malignancy in patients with celiac disease.

    Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI.

    Departments of Medicine (PHRG, RG, AIN), College of Physicians and Surgeons, New York, New York, USA

    Studies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkins lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if a gluten-free diet is protective. Patients with celiac disease seen between July 1981 and January 2000 at a referral center were included. Standardized morbidity ratios (SMRs) (ratio of observed to expected) and corresponding 95% confidence intervals (CI) were calculated, using data from the National Cancer Institutes Surveillance, Epidemiology, and End Results Program. Forty-three (11%) of 381 celiac disease patients had a diagnosis of cancer; 9 were after the diagnosis of celiac disease, 7 were simultaneous (during same month of admission), and 27 were before the diagnosis. The standardized morbidity ratio for all cancers combined was 1.5 (95% CI: 0.3 to 7.5), with significantly increased values for small bowel cancer (SMR = 34; 95% CI: 24 to 42), esophageal cancer (SMR = 12; 95% CI: 6.5 to 21), non-Hodgkins lymphoma (SMR = 9.1; 95% CI: 4.7 to 13), and melanoma (SMR = 5.0; 95% CI: 2.1 to 12). Following the diagnosis of celiac disease, patients were at increased risk of non-Hodgkins lymphoma only (SMR = 6.2; 95% CI: 2.9 to 14), despite adherence to a gluten-free diet. The non-Hodgkins lymphoma included both T-cell and B-cell types and occurred in both gastrointestinal (n = 5) and extra intestinal sites (n = 4). In this cohort of patients with celiac disease, we observed increased risks of small intestinal adenocarcinoma, esophageal cancer, melanoma, and non-Hodgkins lymphoma. The risk of non-Hodgkins lymphoma persisted despite a gluten-free diet.


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    This is great info on celiac disease as I was diagnosed with celiac and my mom died of esophagus cancer age 102 years so I should really be on the watch for that disease. Thank you.

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    I am 37 years old and I was diagnosed with NHL two years ago. I have been in remission for a year. This month I was also diagnosed with Celiac disease. I feel like I finally found the answer I have been looking for for two years. Thank you.

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  • About Me

    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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