Background and aims: The association between diagnosed coeliac disease and malignancy has been established. We studied whether previously unrecognized and thus untreated adults with screening-identified evidence of coeliac disease carry an increased risk of malignancies.
Methods: A Finnish population-based adult-representative cohort of 8000 individuals was drawn in 1978-80. Stored sera of the participants with no history of coeliac disease or any malignancy were tested for IgA-class tissue transglutaminase antibodies (Eu-tTG) in 2001. Positive sera were further analyzed by another tissue transglutaminase antibody test (Celikey tTG) and for endomysial antibodies (EMA). Malignant diseases were extracted from the nationwide database and antibody-positive were compared to negative cases during a follow-up of nearly 20 years.
Results: Altogether 565 of all the 6849 analyzed serum samples drawn in 1978-80 were Eu-tTG-positive. In further analyzes 202 (2.9 %) of the participants were Celikey tTG and 73 (1.1%) EMA-positive. The overall risk of malignancy was not increased among antibody-positive cases in the follow-up of two decades; the age- and sex-adjusted relative risk was 0.91 (95 % CI 0.60-1.37) for Celikey tTG and 0.67 (95 % CI 0.28-1.61) for EMA positives.
Conclusions: The prognosis of adults with unrecognized celiac disease with positive coeliac disease antibody status is good as regards the overall risk of malignancies. Thus, current diagnostic practise is sufficient and there is no need for earlier diagnosis of celiac disease by mass-screening on the basis of this study.