If you have coeliac disease, it is crucial you do not eat any gluten. If you have untreated or undiagnosed coeliac disease and are still eating gluten, several complications can occur.
This particular statement was taken from the NHS choice website, but we often read similar statements. The list of possible complications that can occur most often includes cancer. But what does this really mean and what is the risk?
I decided to look into this further. I will start with the not so good news and will end with great news…
Coeliac disease has been associated with an increased risk of developing some types of cancer, with the highest risk being the development of lymphoma.
A lymphoma is is a type of cancer that begins in immune system cells called lymphocytes. According to Cancer Research UK, coeliac disease was originally associated with a rare type of lymphoma of the small intestine called enteropathy type T cell lymphoma (ETTL) or enteropathy associated T cell lymphoma (EATL). It is rare, even in the general population, where it affects around one in a million people. So, even with the increased risk of this cancer in coeliacs, it is still very rare. People diagnosed with refractory coeliac disease are at the highest risk.
More recently, researchers have found that while ETTL is the most common type of lymphoma associated with coeliac disease, there is an increased risk of other types of non Hodgkin lymphomas. Non-Hodgkin’s lymphoma can affect any part of the body including the small bowel, stomach and bones.
Cancer Research UK go on to say that compared with the general population, people with coeliac disease also have an increased risk of developing some other cancers, including:
- oesophageal cancer (cancer that occurs in the oesophagus — a long, hollow tube that runs from your throat to your stomach that carries food you swallow to your stomach to be digested)
- cancer of the small bowel, also known as adenocarcinoma of the small bowel.
However, researchers have yet to agree how much the risk is increased, and opinions vary. According to an article by Freeman (2009), the precise risk of malignant disease in adult coeliac disease is difficult to evaluate, but about 8%-10% with severe biopsy changes develop lymphoma. The age of diagnosis of coeliac disease seems to be a critical factor- those diagnosed late in life might having a much higher detection of lymphoma. This is because the gluten-free diet would have begun later in life.
And now for the good news:
Most people with coeliac disease do not develop the cancers associated with coeliac disease. Following a gluten free diet reduces the already low risk of developing these types of cancer. Research suggests that the risk of developing these specific types of cancer decreases with time from when you are diagnosed and becomes nearly the same as the risk to the general population.
This is just another reason to adhere to the strict gluten free diet. It seems to be the only way of reducing the risk of rare, but aggressive forms of cancer.
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