Monday, August 05, 2013

Celiac Disease & Cancer Risk (Lymphoma) : New Study Confirms Increased Risk

Lymphoma Risk Elevated in Persons with Celiac Disease

Latest Scientific Study Confirms Elevated Risk

I was just reading newly released study findings about Celiac Disease and an associated risk of Lymphoma (a type of blood cancer) and lymphoproliferative malignancy.  Headlines like this are always concerning for those of us facing a lifetime with Celiac Disease and this one definitely gave me further incentive to do everything in my power to maintain a 100% gluten-free diet.  In summary, as quoted from the article:
"Patients with celiac disease have an elevated risk for lymphoproliferative malignancies, particularly if they have persistent villous atrophy, a population-based cohort study found."
Well, that sure does not sound very cool!  And, it is a bit frightening to see the words lymphoma / cancer associated with Celiac Disease.  I have seen other associations in the past, but this latest study really made clear the raw risk "multiplier" that we CD persons face vs. the "average population" or whatever.

You have Celiac Disease. Should you be concerned?

A key phrase to pay special attention to in that quote is: "...particularly if they have persistent villous atrophy".  Persistent villous atrophy is the state your intestinal villi are much more likely to be in if you do not adhere to a permanent strict 100% gluten-free diet.

Say no more: I will do everything possible to avoid getting gluten in my diet. Heck, I was already "paranoid" (by some accounts), and now I am probably going to be ever more extreme in my caution.  As best as is possible and within my control, it seems foolish for me not to try to maintain 100%-GF status when there are substantial consequences for not doing so.

The numbers (from the study) now:  basically, your risk of lymphoma (as a person with Celiac Disease) is going to be a full FIFTY PERCENT HIGHER (+50%) than the celiac-disease cohort mean-value IF you present with persistent villous atrophy over a long period (in this study, 9 years was the period discussed in the following quote), as would be much more likely if you do not remain 100% "clean" (i.e., strict gluten-free diet):
"During a median follow-up time of 9 years after the second biopsy, 53 patients (0.7%) were diagnosed with a lymphoproliferative malignancy. The incidence in the overall group was 67.9 per 100,000 patient-years
In contrast, the incidence in those with ongoing villous atrophy was 102.4 per 100,000, the researchers reported."
I arrived at the "FIFTY PERCENT" figure through simply math (102 / 68 = 1.5, or, 50% greater).  I consider that a substantial and noteworthy increase in risk.

But, the study did not even stop there, as they went on to assign "hazard ratios" to more detailed sub-groups within the study population, and at specific times within the study (e.g., 12 months after second biopsy still showing atrophy).  Basically, the hazard-ratio is the increased likelihood, expressed as a multiplier, of something happening that you don't want to happen.  Some very specific hazard-ratios went rather high (up to NINE+ TIMES the baseline rate), as stated in these quotes:
"Among these patients with persistent villous atrophy, the higher risk was most prominent during the first 12 months after the follow-up biopsy, with a hazard ratio of 3.67 (95% CI 0.80-16.86), decreasing to 1.99 (95% CI 0.79-4.97) after 5 years.
[...]
An additional factor that was associated with greater risk was biopsy evidence of total or subtotal villous atrophy (HR 3.96, 95% CI 1.65-9.50), which was particularly pronounced in patients with T-cell lymphoma, who had nine times the risk (HR 9.23, 95% CI 1.66-51.34)."

And, basically the takeaway I am getting from all this is that, yes, if you have CD and present with persistent villous atrophy, you should be somewhat concerned.  First of all, you have to consider whether you are doing everything in your power to maintain a truly "clean" diet (gluten-free diet), since that is first and foremost the best thing you can do to minimize the villi issues.

Hopefully we can all manage to minimize mucosal damage (and especially persistent damage) to our intestinal villi through a strict gluten-free diet!  Yes, some of us will face a very difficult  time recovering from exposure to gluten (especially since it is so darn difficult to avoid the occasional accidental cross-contamination and so forth), but we must do our utmost to TRY to maintain our strict diets.  

Luckily, the Federal USA government is stepping into the scene with regards to gluten-free labeling laws and all (was big news this past week -- which I plan to summarize and blog about soon), as this should help make it easier for us to know (with a higher degree of certainty) what is truly "gluten free" on the store shelves.  But, even with that, there is a lot of vigilance and diligence required on our part to stay GF all the time.

Continue to read this Gluten-Free Blog for all sorts of gluten-free recipes, product-reviews, and related information. In addition, visit my Gluten-Free Recipes Site where many of the recipes I have featured on this blog are available

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