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March 31, 2009; 72 (13) Articles

Cancer risk among patients with multiple sclerosis and their parents

S. Bahmanyar, S. M. Montgomery, J. Hillert, A. Ekbom, T. Olsson
First published March 30, 2009, DOI: https://doi.org/10.1212/01.wnl.0000345366.10455.62
S. Bahmanyar
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S. M. Montgomery
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J. Hillert
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A. Ekbom
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Citation
Cancer risk among patients with multiple sclerosis and their parents
S. Bahmanyar, S. M. Montgomery, J. Hillert, A. Ekbom, T. Olsson
Neurology Mar 2009, 72 (13) 1170-1177; DOI: 10.1212/01.wnl.0000345366.10455.62

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Abstract

Background: We investigated cancer risk among patients with multiple sclerosis (MS) and whether variation by age at MS diagnosis helps to elucidate mechanisms underlying the previously reported reduced cancer risk. We also studied cancer risk among parents to ascertain if MS susceptibility genes may confer protection against cancer in relatives.

Methods: Cox proportional hazards regression, adjusted for age, sex, area, and socioeconomic index, estimated cancer risk among 20,276 patients with MS and 203,951 individuals without MS, using Swedish general population register data. Similar analyses were conducted among 11,284 fathers and 12,006 mothers of patients with MS, compared with 123,158 fathers and 129,409 mothers of controls.

Results: With an average of 35 years of follow-up, there was a decreased overall cancer risk among patients with MS (hazard ratio = 0.91, 0.87–0.95). Increased risks were observed for brain tumors (1.44, 1.21–1.72) and urinary organ cancer (1.27, 1.05–1.53). Parents of patients with MS did not have a notably increased or decreased overall cancer risk.

Conclusions: The reduction in cancer risk in patients with multiple sclerosis (MS) may result from behavioral change, treatment, or we speculate that some immunologic characteristics of MS disease activity improve antitumor surveillance. The lack of association among parents indicates that a simple inherited characteristic is unlikely to explain the reduced cancer risk among patients with MS. MS is associated with increased risk for some cancers, such as of urinary organs and brain tumors (although surveillance bias may be responsible).

Glossary

CI=
confidence interval;
HR=
hazard ratio;
MS=
multiple sclerosis.
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Letters: Rapid online correspondence

  • Glial brain tumors in patients with multiple sclerosis
    • Silvia Hofer, Dept. of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerlandsilvia.hofer@usz.ch
    • Michael Linnebank, Michael Weller
    Submitted August 20, 2009
  • Reply from the authors
    • Shahram Bahmanyar, Karolinska Institutet, Clinical Epidemiology Unit, Dept. of Medicine, Karolinska Institutet, Karolinska Hospital, Swedenshahram.bahmanyar@ki.se
    • S. M. Montgomery, J. Hillert, A. Ekbom, and T. Olsson
    Submitted August 20, 2009
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