Risk of malignancy in diagnosed coeliac disease: a 24-year prospective, population-based, cohort study

Background: There is recent evidence from studies of hospitalized and of undiagnosed patients that the risk of lymphoma for people with coeliac disease may be lower than previously thought. In addition, there have been no precise estimates of small bowel lymphoma risk due to a lack of population data. Aim: To examine these and other malignant risks in a cohort of patients more typical of those seen in routine clinical practice. Methods: A prospective cohort study of incident malignancy rates in patients with coeliac disease in southern Derbyshire compared with general population figures. Results: During 5684 person years of follow-up 31 malignancies (excluding non-melanoma skin cancer) occurred in comparison with 30.30 expected [standardized incidence ratio (SIR) 1.02 (0.69-1.45)]. There were four non-Hodgkin's lymphomas (0.69 expected) SIR 5.81 (1.58-14.86), of which one originated in small bowel (0.02 expected) SIR 40.51 (1.03-225.68). GI malignancy occurred in nine (5.71 expected) SIR 1.58 (0.72-2.99), and breast cancer in three (5.08 expected) SIR 0.59 (0.12-1.73). Conclusions: There is no increase in the risk of incident malignancy in this population and the risk of non-Hodgkin's lymphoma in general or of the small bowel is lower than previously found from UK coeliac cohorts.