Cancer Risk in Clinically Recognized Celiac Disease: A Nationwide Propensity-Matched Cohort Study

Area of Science:

• Gastroenterology and Hepatology
• Oncology
• Epidemiology

Background:

• Celiac disease (CD) is a common autoimmune disorder.
• The cancer risk profile associated with CD is not fully understood.
• Previous estimates vary due to methodological differences.

Purpose of the Study:

• To evaluate cancer-category-specific associations in a matched cohort of individuals with clinically recognized celiac disease.
• To investigate the relationship between CD and the risk of developing various invasive cancers.

Main Methods:

• Utilized longitudinal electronic health record (EHR) data from Clalit Health Services.
• Employed propensity-score matching to create a cohort of CD patients and controls.
• Analyzed EHR-coded invasive oncology outcomes using Cox models, with sensitivity analyses including lag analyses and competing-risk modeling.

Main Results:

• The primary cohort included 1006 CD patients and 7137 controls.
• Celiac disease was associated with an increased hazard of invasive cancer (HR 1.61).
• Strongest associations were observed for hematological malignancy (HR 1.99), lymphoma (HR 1.90), and gastrointestinal (GI) cancer (HR 2.71) codes.

Conclusions:

• Clinically recognized celiac disease is linked to an elevated and category-specific cancer hazard.
• The findings indicate a concentrated risk in hematological, lymphoid, and GI cancers, with a notable signal for gut-oriented T-cell lymphoma.
• The results support targeted clinical vigilance for celiac disease patients, not widespread screening.