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Celiac Disease Malignancy Risk Higher Despite Gluten-free Diet

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

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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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3 Responses:

 
Anita Lesniak
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said this on
20 Mar 2008 9:48:49 AM PDT
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.

 
sheila
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said this on
14 Aug 2008 12:01:18 PM PDT
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.

 
William Narcowich
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said this on
12 Nov 2012 12:52:51 PM PDT
A new concern, but also comfort on gastrointestinal cancer.




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Yeah we learned that the hard way. I am inclined to think (as I did initially) that it was JUST the Cheerios but as time is passing and she is not bouncing back I am worried that we need to strip away dairy again for a while.

Oh I have no issue with being dairy free personally but tell that to a 13 year old. We both went gluten-free at the same time and it has been mindlessly easy for me. But I am easy about food and no real food issues. I am far more adaptable. She comes to the table with her own unique set of issues that complicate just easily transitioning to dairy free versions of much loved favorites. To most they are jst that "substitutes" to her they are completely different foods and ones that she has no interest in eating. They don't satisfy her need for XYZ. It is like craving an apple and someone handing you a fish. For her anyway! LOL!

I believe the talk around this forum is that cheerios are not gluten free enough for people with celiac at this time. I don't know if anything has changed on that and when their lawyer calls me I'll quickly delete this. haha

Could be we generally say get off of dairy for a few months when going gluten free. The part of the intestines that produce the enzymes, and help break down dairy are associated with the tips of the villi, which are the most damaged if not gone in celiacs. THIS is why most of us end up with a lactose intolerance early on. And most can introduce it later after healing. As to her symptoms with it there was a bunch of research about dairy permeated the gut and causing neurological issues in a autism study I was looking at years ago. And there have been other studies about damaged intestines and how the hormones in milk can easier effect ones body. Personally I also have a huge grudge against dairy on a personal level as it is not natural to suck on a cows tits and drink the stuff, nor your dogs, nor a rabbits......I mean come on even Human Breast milk you would find odd to drink as an adult right? Back in the past dairy was a great way to get calories and fats when there was famine, etc around I mean it is meant to make a calf grow into a 500+lb cow. But on a genetic and hormonal level it is not really for human consumption and now days the whole corporate BS propaganda push and dairy farms shove that oh its healthy stuff down your throat. There are plenty of dairy free options for everything feel free to message me if you need help finding anything I have been dairy free for over a decade.

The full celiac panel checks TTG IGA and IGG, DGP IGA and IGG, IGA, EMA as Jmg stated above. Your test included TTG IGA and IGA. If your IGA was low, a low on TTG IGA would be inconclusive. But your IGA is fine. A high on any one test is a positive for celiac and should lead to an endoscopy for confirmation. So I'd get tested for TTG IGG, DGP IGA and IGG and EMA since there are symptoms. Warning I'm not a doc.