For most of us, we avoid gluten because it makes us feel bad. It can make some of us feel really, really bad. But for others diagnosed with celiac disease, there is no real consequence to eating gluten. They don’t feel bad ever, but still have damage to their intestines from gluten. These are the silent celiac patients. We all avoid gluten due to the damage and potential risk of cancer.
But what are the real risks of cancer to a celiac patient? If we get cancer, how bad is it? When I say that – some cancers are worse than others. Metastatic breast cancer is far worse than stage 1 breast cancer because metastatic breast cancer affects more systems in the body. Metastatic breast cancer has a 3 year survival rate of 22%, while stage 1 breast cancer has a 5 year survival rate of over 90%. So, any cancer is bad, but some are worse.
In December 2018, a group did a study of celiac disease and cancer risk. They looked at a database from the Netherlands that tracks cancer and celiac diagnosis. They compared the rates of malignant lymphoma or GI carcinoma to the rates of melanoma or basal cell carcinoma. They chose melanoma or basal cell carcinoma as controls because those cancers are typically unrelated to a celiac diagnosis.
They tracked the rates of cancer diagnosis vs the rates of celiac diagnosis over the course of 12 years to find the relative risks and absolute risks of developing lymphoma or a GI carcinoma in celiac patients.
First they found that enteropathy-associated T-cell lymphoma (EATL) is often diagnosed at the same time doctors find celiac disease. EATL is often called “celiac cancer” because it is so closely associated with celiac. There is no other known cause for EATL. Also, one year after celiac diagnosis the relative risk of EATL diagnosis remains higher than expected. There are two other cancers associated with celiac disease as well – small bowel adenocarcinoma and esophageal squamous cell carcinoma.
Specifically about celiac cancers, the study says, “Absolute celiac disease-associated risks of malignancies were relatively low with a highest absolute risk of 4.3% for T-cell lymphoma in males between the age of 50 and 80 years when CD is diagnosed at age 50 years.” So, if you are a man diagnosed with celiac at or after 50, you have the highest risk of developing a celiac-related cancer before age 80.
In contrast, the one of the most common cancer diagnoses is for colorectal cancer. The current diagnosis rate of colorectal cancer is 4.5%, so the highest risk of developing a celiac related cancer is about the same as colorectal cancer.
In summary, cancer is a very real possibility for those with celiac disease, but it is of no higher risk than colon cancer to the non-celiac population. I think we should all be aware of the risks, but not step over the line into paranoia about getting cancer. Twelve percent of women and eleven percent of men will be diagnosed with breast cancer or prostate cancer over the course of their lives. It is more likely someone will be diagnosed with breast or prostate cancer than a celiac-related cancer. I’d be more worried about breast or prostate cancer than a celiac-related cancer to be honest. But that doesn’t give permission to slip up on a gluten free diet.
As a celiac, what are the signs of cancer to be aware of? Blood in stool, etc.?
It is the same as all other cancer signs and symptoms – excessive fatigue, bleeding out of anywhere that shouldn’t, enlarged lymph nodes, or dramatic changes in weight without trying. If concerned, you should check with your doctor. The point it, though, while we have a slightly increased risk for more dangerous cancer, our overall risk isn’t much greater for cancer than the non-celiac population.