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agate
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 Posted: Tue Jun 26, 2012 3:01 pm Post subject: (Abst.) Cancer risk in MS: findings from BC (Canada) |
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From PubMed, June 26, 2012:
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Brain. 2012 Jun 21.
Cancer risk in multiple sclerosis: findings from British Columbia, Canada
Kingwell E, Bajdik C, Phillips N, Zhu F, Oger J, Hashimoto S, Tremlett H.
Division of Neurology, Faculty of Medicine, Multiple Sclerosis Program, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
Findings regarding cancer risk in people with multiple sclerosis have been inconsistent and few studies have explored the possibility of diagnostic neglect. The influence of a relapsing-onset versus primary progressive course on cancer risk is unknown.
We examined cancer risk and tumour size at diagnosis in a cohort of patients with multiple sclerosis compared to the general population and we explored the influence of disease course.
Clinical data of patients with multiple sclerosis residing in British Columbia, Canada who visited a British Columbia multiple sclerosis clinic from 1980 to 2004 were linked to provincial cancer registry, vital statistics and health registration data. Patients were followed for incident cancers between onset of multiple sclerosis, and the earlier of emigration, death or study end (31 December 2007). Cancer incidence was compared with that in the age-, sex- and calendar year-matched population of British Columbia. Tumour size at diagnosis of breast, prostate, colorectal and lung cancers were compared with population controls, matched for cancer site, sex, age and calendar year at cancer diagnosis, using the stratified Wilcoxon test.
There were 6820 patients included, with 110 666 person-years of follow-up. The standardized incidence ratio for all cancers was 0.86 (95% confidence interval: 0.78-0.94). Colorectal cancer risk was also significantly reduced (standardized incidence ratio: 0.56; 95% confidence interval: 0.37-0.81). Risk reductions were similar by sex and for relapsing-onset and primary progressive multiple sclerosis. Tumour size was larger than expected in the cohort (P = 0.04).
Overall cancer risk was lower in patients with multiple sclerosis than in the age-, sex- and calendar year matched general population. The larger tumour sizes at cancer diagnosis suggested diagnostic neglect; this could have major implications for the health, well-being and longevity of people with multiple sclerosis.
PMID:22730559 |
The abstract can be seen here. |
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agate
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| Posted: Fri Jun 29, 2012 6:17 pm Post subject: |
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More about this in Medical News Today, June 28, 2012:
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Cancer Risk Lower In Multiple Sclerosis Patients
Individuals with multiple sclerosis (MS) are less likely to develop cancer, according to researchers.
The study, conducted by researchers at the University of British Columbia and Vancouver Coastal Health, is published in the journal Brain.
Lead author of the study Elaine Kingwell, a postdoctoral fellow in the UBC Faculty of Medicine and Brain Research Center at UBC and VCH Research Institute, explained:
"Because the immune system plays important roles in both cancer and MS, we wanted to know whether the risk of cancer is different for people with MS. Not only did MS patients have a lower overall cancer risk, the risk for colorectal cancer in particular was significantly lower."
After comparing diagnoses of cancer in MS patients in British Columbia with those of the general public, the researchers discovered that MS patients were less likely to develop cancer. In particular MS patients had a lower risk of developing colorectal cancer. However, the team found that these patients had a slightly increased risk of developing brain and bladder cancer, although this increase was not significant. Furthermore, the risk for non-melanoma skin cancer was significantly higher among patients with relapsing-onset MS.
The researchers note that further studies are required in order to understand why MS patients have a reduced overall risk of developing cancer.
The researchers also found that MS patients who developed cancer usually had larger tumors at time of diagnosis. They state that more research is needed to find out why some tumors might be caught later in individuals with MS.
Helen Tremlett, associate professor in the UBC Faculty of Medicine, said: "Because the symptoms of MS can be broad and include feelings of fatigue, it's possible the symptoms of cancer are being masked or overlooked."
Tremlett states that MS patients and their physicians should continue to follow cancer screening guidelines, regardless of the study findings. A follow-up study is planned in order for the researchers to determine if cancer mortality rates are altered in MS patients.
Written by Grace Rattue
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The article can be seen here. |
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agate
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| Posted: Sun Jul 21, 2013 10:58 pm Post subject: Evidence of delayed cancer detection in MS patients |
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A somewhat different perspective, from The Oncology Report, July 15, 2013:
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Evidence of delayed cancer detection in MS patients
By: BRUCE JANCIN, Oncology Report Digital Network
ORLANDO – Patients with multiple sclerosis are at significantly reduced risk of being diagnosed with cancer, compared with the general population, but delayed cancer detection – that is, diagnostic neglect – appears to be a contributing factor, a study from British Columbia has shown.
"Diagnostic neglect is unlikely to account for the entire reduced cancer risk that we’re seeing, but I think it could have major implications for the health, well-being, and longevity of people with multiple sclerosis," said Helen Tremlett, Ph.D, a neuroepidemiologist at the University of British Columbia, Vancouver.
In the population-based Malignancy and Multiple Sclerosis (MaMS) study, she and her coinvestigators linked data from the British Columbia MS registry with the provincial cancer registry. The study included 6,820 MS patients who visited a British Columbia MS clinic in 1980-2004. Most had never been exposed to an immunomodulatory therapy. They had a collective 110,666 person-years of follow-up. Their cancer incidence over time was compared with that of the age-, sex-, and calendar year–matched general population of British Columbia.
The standardized incidence ratio for all cancers in the MS cohort was 0.86, meaning MS patients had a highly significant overall 14% reduction in the risk of being diagnosed with cancer. The risk reduction was particularly striking for colorectal cancer: Patients with MS were 44% less likely than controls to be diagnosed with this malignancy.
The cancer risk reductions were similar in men and women with MS, and in those with relapsing-remitting as compared with primary progressive MS, Dr. Tremlett reported at the fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.
Of note, the cancer risk reduction identified in the MaMS study was consistent with an earlier meta-analysis of five studies by other investigators around the world, who concluded that the risk of being diagnosed with cancer was 8% lower in MS patients than controls, a statistically significant difference (J. Neurol. Neurosurg. Psychiatry 2010;81:1413-4).
Unlike the other researchers, however, Dr. Tremlett and her coworkers also looked at tumor size at the time of diagnosis for the four most common cancers: breast, prostate, lung, and colorectal cancer. They found a consistent pattern: MS patients diagnosed with cancer had a lower-than-expected rate of the smaller T1 and T2 tumors than in the matched general population with cancer, and a greater-than-expected rate of T3 and T4 tumors.
The most likely explanation for the observed larger-than-expected tumor size is that when MS patients report, say, a new sense of fatigue, it may be ascribed to their MS, whereas if a patient from the general population had the same complaint, a battery of tests would be ordered, she said.
The MS patients’ 14% reduction in the risk of being diagnosed with cancer had an impressive P value. In contrast, the association between MS and larger tumor size, while statistically significant, had a less than stellar P value of .04. For this reason, Dr. Tremlett said she doesn’t believe diagnostic neglect is the entire explanation for the MS patients’ reduction in cancer incidence. Other possible contributing factors worthy of further study are that MS patients’ hypervigilant immune system renders them less vulnerable to cancer growth, or that MS and cancer share a common and as-yet-unidentified genetic predisposition, or that upon receiving the diagnosis of MS, affected patients adopt a healthier lifestyle.
Dr. Tremlett stressed the importance of being on the lookout for cancer and other aging-related comorbidities, especially now that patients with MS are living longer. In a recent study of 6,917 MS patients in British Columbia, she and her coinvestigators determined that the median survival age was 78.6 years for women and 74.3 years for men. Those are some of the longest life spans ever reported, but still about 6 years less than expected for the general British Columbia population.
Median survival from disease onset was markedly longer for patients with relapsing-onset MS than primary progressive MS: 49.7 years compared with 32.5 years. However, the two groups lived to about the same age.
Patients with primary progressive MS had a 1.52-fold greater relative mortality risk than did those with relapsing-onset MS. Women with primary progressive MS had a 1.55-fold survival disadvantage compared with men with primary progressive disease (J. Neurol. Neurosurg. Psychiatry 2012;83:61-6).
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The MaMS study is sponsored by the Canadian Institutes of Health Research and the Multiple Sclerosis Society of Canada. Dr. Tremlett reported having no relevant financial disclosures. |
The article can be seen here. |
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