Evidence of delayed cancer detection in MS patients

ORLANDO – Patients with multiple sclerosis are at significantly reduced risk of being diagnosed with cancer, compared with the general population, but delayed cancer detection – that is, diagnostic neglect – appears to be a contributing factor, a study from British Columbia has shown.

“Diagnostic neglect is unlikely to account for the entire reduced cancer risk that we’re seeing, but I think it could have major implications for the health, well-being, and longevity of people with multiple sclerosis,” said Helen Tremlett, Ph.D, a neuroepidemiologist at the University of British Columbia, Vancouver.

In the population-based Malignancy and Multiple Sclerosis (MaMS) study, she and her coinvestigators linked data from the British Columbia MS registry with the provincial cancer registry. The study included 6,820 MS patients who visited a British Columbia MS clinic in 1980-2004. Most had never been exposed to an immunomodulatory therapy. They had a collective 110,666 person-years of follow-up. Their cancer incidence over time was compared with that of the age-, sex-, and calendar year–matched general population of British Columbia.

The standardized incidence ratio for all cancers in the MS cohort was 0.86, meaning MS patients had a highly significant overall 14% reduction in the risk of being diagnosed with cancer. The risk reduction was particularly striking for colorectal cancer: Patients with MS were 44% less likely than controls to be diagnosed with this malignancy.

The cancer risk reductions were similar in men and women with MS, and in those with relapsing-remitting as compared with primary progressive MS, Dr. Tremlett reported at the fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Of note, the cancer risk reduction identified in the MaMS study was consistent with an earlier meta-analysis of five studies by other investigators around the world, who concluded that the risk of being diagnosed with cancer was 8% lower in MS patients than controls, a statistically significant difference (J. Neurol. Neurosurg. Psychiatry 2010;81:1413-4).

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