Why Celiac Disease Significantly Raises Your Risk for Lymphoma

A loaf of sliced gluten-free bread on a floured table

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If you have celiac disease, you also likely have a higher-than-normal risk of developing non-Hodgkin lymphoma.

This may seem frightening, and it's certainly something that you should take seriously–and probably discuss with your doctor. But a closer look at the numbers indicates that your overall risk of getting lymphoma, while higher than average, is still pretty small ... and you may be able to mitigate that risk further by following a strict gluten-free diet.

If you have non-celiac gluten sensitivity, at least one study has shown that you, too, may have a higher risk of non-Hodgkin lymphoma. However, the evidence is far less clear for those with gluten sensitivity. 

Non-Hodgkin Lymphoma Found in 3.1% of Celiacs

Non-Hodgkin lymphoma is cancer involving the lymphatic system, which includes components of your immune system such as your lymph nodes and spleen. About one in 50 people—or 2 percent—will develop non-Hodgkin lymphoma during their lifetimes.

It's not clear exactly how many people with celiac disease will develop non-Hodgkin lymphoma over their lifetimes. One study—which looked at the incidence of lymphoma and similar disorders at the Columbia University Celiac Disease Center—found 40 cases of non-Hodgkin lymphoma out of 1,285 celiac patients seen at the center between 1981 and 2010, for a rate of 3.1 percent.

Another study found a much higher rate in people whose celiac disease had led to hospitalization (meaning it was more severe than average). Those people had a 5.35-fold increased risk of non-Hodgkin lymphoma, which could mean around one in 10 of that more severely ill group might develop the condition over their lifetimes.

Therefore, although the overall risk for non-Hodgkin lymphoma is higher in people with celiac disease than it is for people who don't have the condition, it's not that much higher for people who haven't been hospitalized. But people who have been hospitalized are more likely to have refractory celiac disease, a form of the condition that doesn't respond to the gluten-free diet.

Interestingly, researchers have also found an elevated risk for non-Hodgkin lymphoma in non-celiac siblings of diagnosed celiacs, indicating there may be some genes that raise the risk both for celiac disease and for lymphoma.

Specific Form of Lymphoma Closely Linked to Celiac Disease

People who've been diagnosed with the celiac disease appear to be at a higher risk for all types of non-Hodgkin lymphoma (there are more than 30 types). But the risk of one particular type—enteropathy-associated T-cell lymphoma, or EATL, that begins in the small intestine—is specifically associated with celiac disease.

EATL is a very rare cancer—fewer than one person per million people in Western countries develop EATL each year. By definition, EATL develops in patients with celiac disease, although sometimes it's diagnosed at the same time or even before the person is diagnosed with celiac.

Sadly, the outlook for this type of cancer is poor: two separate studies have found average survival is only about three to three-and-a-half years, compared to 15 years for other forms of non-Hodgkin lymphoma. Another study found the median overall survival was just 10 months, while another reported a seven-month survival rate.

Incidence of EATL in the U.S. appears to be increasing, according to a 2012 study in the journal Cancer. The authors said this may reflect the increasing prevalence of celiac disease and better recognition of rare types of T-cell lymphomas.

Older Celiac Lymphoma Patients Exhibit More 'Traditional' Symptoms

Lymphoma in people with celiac disease typically develops in the five to 10 years following the celiac diagnosis, although doctors have recorded cases of a 60-year time lapse between the two diagnoses.

It's common for celiacs who ultimately are diagnosed with lymphoma to experience a relapse of their condition with a recurrence of celiac disease symptoms (even if their symptoms had been well under control previously). However, some people experience a progressive deterioration, are diagnosed with refractory celiac disease, and then develop lymphoma.

Studies show that celiac disease patients who develop disorders of the lymphatic system, including lymphoma, tend to be older at the time of their celiac disease diagnosis, and are more likely to suffer from symptoms of diarrhea, abdominal pain and weight loss (symptoms indicating severe villous atrophy and malabsorption) than other celiacs.

Can Eating Gluten-Free Help Reduce Your Lymphoma Risk?

Although not all studies agree, the most recent medical research seems to indicate that adhering to a strict gluten-free diet can reduce your risk of developing non-Hodgkin lymphoma and other types of cancer.

Italian researchers, writing in the journal Digestive Diseases and Sciences, reported on 1,757 celiac disease patients, out of whom nine developed an intestinal lymphoma. Of those nine, most didn't follow a strict gluten-free diet, the researchers said.

It appears to matter how long you ate gluten prior to your celiac diagnosis and how long you stay off it following diagnosis. A study from Sweden reports that children diagnosed before they turn 10 show no increase in cancer risk. In addition, after adults spent 10 or more years on the gluten-free diet, the study showed their cancer risks returning to almost normal. Other studies also show the risk of cancer decreases the longer you're gluten-free.

Therefore, even though your risk of developing lymphoma is still pretty small, the best thing you can do to protect yourself against that deadly condition is to not cheat on the gluten-free diet.

In addition, if you ever develop any symptoms of non-Hodgkin lymphoma (which can include swollen lymph nodes, fatigue, unexplained weight loss, fever and night sweats), you should talk to your doctor immediately, and make sure she knows the connection between lymphoma and celiac disease.

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