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Celiac & Cancer: How To Lower Your Risk

Does having celiac disease increase my risk of cancer?

Gluten free = cancer preventionIt may, especially if you are not following a gluten-free diet. People with celiac disease seem to have an elevated risk for cancers of the small intestine, such as small bowel adenocarcinoma (normally a very rare cancer). In some ways this is not surprising, since people with celiac disease have an autoimmune response that damages the inner lining of the small intestine.

Parts of the body that are repeatedly exposed to abnormal stresses and pressures may be subject to dysplasia, abnormal tissue growth that can sometimes lead to cancer. The risk appears to be highest in people with longstanding celiac disease, especially when left untreated, and is higher for older adults than for younger adults or adolescents.

Several studies have also found an increased risk for multiple types of lymphomas. (These may originate from immune cells of the small intestine or from elsewhere in the body.) These include the rare enteropathy-type T cell lymphoma, other T cell lymphomas, and B cell non-Hodgkin type lymphomas.

Researchers aren’t sure exactly how much having celiac disease increases one’s risk of cancer, as large studies are limited, but they do think it is probably less than was previously believed. One study found that having celiac disease may increase the risk of small bowel adenocarcinoma by about ten fold. (But because this cancer is so rare, the risk is still only a moderate one.) That same study showed that celiac disease may increase the risk of lymphoma by about six fold.

Does following a gluten-free diet decrease this risk of cancer?

Yes. Gluten is what seems to trigger the autoimmune response which attacks the cells of the small intestine. Several studies indicate that following a gluten-free diet can dramatically decrease cancer risk, possibly to a level almost equal to that of people without celiac disease.

This may be especially true if celiac disease is diagnosed earlier and the diet is followed strictly from an earlier age. As the lining of the small intestine heals and inflammation decreases, it makes cancer much less likely. So a person diagnosed at a young age with well managed disease is much less likely to ever develop cancer. The risk of cancer seems to decrease with time out from initial diagnosis (presumably because people begin following the gluten-free diet).

Your eventual risk of cancer may depend on how well your small intestine heals after adopting a gluten-free diet. One study found that people with permanent damage to the inside of their small intestine were more likely to develop lymphoma than other people with celiac disease. How well the intestinal wall heals may depend on many factors, like compliance with the diet and age of initial diagnosis.

It is not known if other factors decrease the risk of cancer in celiac disease in particular. Staying physically active, not smoking, and eating a diet rich in fruits and vegetables can decrease your overall risk of cancer.

How does celiac disease affect my risk for other kinds of cancer?

This is less clear. A Swedish study did find an increased risk of esophageal, pharyngeal, hepatobiliary, and pancreatic cancer in people with celiac disease, but other studies have not repeated these results.

The data for colon cancer are also mixed, with some studies finding an increased risk, and others not showing this risk. (It may be that severe, late-detected celiac disease actually protects against colon cancer, for unknown reasons.) Celiac disease does not seem to increase the risk of stomach cancer.

Celiac disease may actually decrease the risk of breast cancer, endometrial cancer, and ovarian cancer. This may be due to decreased absorption of dietary fats (due to intestinal damage) or other unknown factors.

Questions for your doctor:

  • Do I need increased screening for any types of cancer?
  • How can I tell if my celiac disease is under control?
  • Other than a gluten free diet, is there anything else I can do to decrease my risk of cancer?

 

About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer.  She specializes in writing about medical topics for the lay public and for health science students.  She can be reached at [email protected] or through her website: ruthjhickmanmd.com.

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