Do Individuals With Celiac Disease Really Have an Increased Risk of Cancer?

Do Individuals With Celiac Disease Really Have an Increased Risk of Cancer?

Vanessa M. Shami, MD, FASGE, reviewing Lebwohl B, et al. Clin Gastroenterol Hepatol 2021 May 23.

Diagnosis of celiac disease has increased significantly over the past decade. The risk of cancer in this patient population is thought to be increased, although the data are variable. This population-based Swedish study evaluated cancer risk (both hematologic and solid) in patients with celiac disease. 

A total of 47,241 patients with celiac disease (as defined by duodenal villous atrophy), identified by data from Sweden’s 28 pathology departments (Epidemiology Strengthened by histoPathology Reports in Sweden cohort), were matched with 225,180 controls without celiac disease. Patients were matched by age, sex, and county. A stratified Cox proportional hazards model was used to follow patients from diagnosis until first cancer, or by December 31, 2016. 

After a median follow-up of 11.3 years in patients with celiac disease and 11.5 years in controls, cancer incidence was 6.5 and 5.7 per 1000 person-years, respectively. Although the overall risk of cancer in patients with celiac disease was increased (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.07-1.15), this increase was restricted to the first year following a celiac disease diagnosis (HR, 2.47; 95% CI, 2.22-2.74). One year beyond the diagnosis of celiac disease, the association between celiac disease and cancer was no longer significant (HR, 1.01; 95% CI, 0.97-1.05). The types of cancer that had the strongest association with the diagnosis of celiac disease were hematologic, lymphoproliferative, and gastrointestinal (namely hepatobiliary and pancreatic). The overall risk of cancer was highest in those diagnosed with celiac disease after age 60 years (HR, 1.22; 95% CI, 1.16-1.29) and was not increased in those diagnosed before age 40.

Vanessa M. Shami, MD, FASGE


This study raises the possibility of increased risk of cancer diagnosis within the first year after the diagnosis of celiac disease in patients older than age 40. These findings suggest that a clinician may be well-served to have a high degree of suspicion for cancer in older patients who present with newly diagnosed celiac disease. More data may be helpful to see if these findings are consistent.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Lebwohl B, Green PHR, Emilsson L, et al. Cancer risk in 47,241 individuals with celiac disease: a nationwide cohort study. Clin Gastroenterol Hepatol 2021 May 23. (Epub ahead of print) (

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