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Malignancies in cases with screening-identified evidence of coeliac disease: a long-term population-based cohort study
  1. S Lohi1,
  2. M Mäki1,2,
  3. J Montonen3,
  4. P Knekt3,
  5. E Pukkala4,
  6. A Reunanen3,
  7. K Kaukinen1,5
  1. 1
    Paediatric Research Center, Medical School, University of Tampere, Tampere, Finland
  2. 2
    Department of Paediatrics, Tampere University Hospital, Tampere, Finland
  3. 3
    National Public Health Institute, Helsinki, Finland
  4. 4
    Finnish Cancer Registry, Helsinki, Finland
  5. 5
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
  1. Dr K Kaukinen, Medical School, Building FM3, FIN-33014 University of Tampere, Finland; katri.kaukinen{at}


Background and aims: The association between diagnosed coeliac disease and malignancy has been established. The present study was conducted to determine whether previously unrecognised 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 1978–1980. Stored sera of the participants with no history of coeliac disease or any malignancy were tested for immunoglobulin A (IgA) class tissue transglutaminase antibodies (Eu-tTG) in 2001. Positive sera were further analysed by another tissue transglutaminase antibody test (Celikey tTG) and for endomysial antibodies (EMAs). Malignant diseases were extracted from the nationwide database and antibody-positive cases were compared with negative cases during a follow-up of nearly 20 years.

Results: Altogether 565 of all the 6849 analysed serum samples drawn in 1978–80 were Eu-tTG positive. In further analyses, 202 (2.9%) of the participants were Celikey tTG positive and 73 (1.1%) were 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 to 1.37) for those who were Celikey tTG positive and 0.67 (95% CI 0.28 to 1.61) for those who were EMA positive.

Conclusions: The prognosis of adults with unrecognised coeliac disease with positive coeliac disease antibody status is good as regards the overall risk of malignancies. Thus, current diagnostic practice is sufficient and there is no need for earlier diagnosis of coeliac disease by mass screening on the basis of the findings of this study.

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  • Funding: The Coeliac Disease Study Group is supported by grants from the Competitive Research Funding of Pirkanmaa Hospital District, the Emil Aaltonen Foundation, the Foundation for Paediatric Research, the Yrjö Jahnsson Foundation, the Finnish Coeliac Society and the Academy of Finland, Research Council for Health. The present study was also funded by the Commission of the European Communities in the form of the Research and Technology Development programme “Quality of Life and Management of Living Resources” (QLRT-1999-00037), “Evaluation of the Prevalence of Coeliac Disease and its Genetic Components in the European Population”. The study does not necessarily reflect the current views or future policies of the Commission of European Communities. The authors’ work was independent of the funders.

  • Competing interests: None.

  • Ethics approval: The Ethical Committee of Tampere University Hospital, Tampere, Finland, approved the study protocol.

  • Patient consent: Obtained.

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