Cancer Incidence and Mortality Rates in Multiple Sclerosis

Abstract

Objective:To determine whether cancer risk differs in people with and without multiple sclerosis (MS), we compared incidence rates and cancer-specific mortality rates in MS and matched cohorts using population-based data sources.Methods:We conducted a retrospective matched cohort study using population-based administrative data from Manitoba and Ontario, Canada. We applied a validated case definition to identify MS cases, then selected 5 controls without MS matched on birth year, sex and region. We linked these cohorts to cancer registries, and estimated incidence of breast, colorectal and 13 other cancers. For breast and colorectal cancers, we constructed Cox models adjusting for age at the index date, area-level socioeconomic status, region, birth cohort year and comorbidity. We pooled findings across provinces using meta-analysis.Results:We included 53,984 MS cases and 266,920 controls. Multivariable analyses showed no difference in breast cancer risk (pooled hazard ratio [HR] 0.92 [95%CI: 0.78-1.09]) or colorectal cancer risk (pooled HR 0.83 [95%CI: 0.64-1.07]) between the cohorts. Mortality rates for breast and colorectal did not differ between cohorts. Bladder cancer incidence and mortality rates were higher among the MS cohort. Although the incidence of prostate, uterine and central nervous system cancers differed between the MS and matched cohorts, mortality rates did not.Conclusion:The incidence of breast and colorectal cancers does not differ between persons with and without MS; however, the incidence of bladder cancer is increased. Reported differences in the incidence of some cancers in the MS population may reflect ascertainment differences rather than true differences.

The Quality of Life of People with Solid Cancer is Less Worse than Other Diseases with better Prognosis, Except in the Presence of Depression

“…A significantly higher impact of solid cancers on H-QoL was reported compared with Celiac Disease and Specific Phobia, but lower compared with Multiple Sclerosis and Fibromyalgia [ 26 - 28 , 41 - 46 ]. Despite the considerable impact that having a tumor can imply on the life of an individual, nonetheless highly disabling chronic diseases that do not have an equally “quoad vitam” prognosis, such as Multiple Sclerosis [ 51 ] or Fibromyalgia [ 52 ], present a burden attributable to worsening the H-QoL much higher than solid cancer.…”

Incidence of malignant neoplasms and mortality in people affected by multiple sclerosis in the epoch of disease-modifying treatments: A population-based study on Tuscan residents

“…These data are aligned with previous observations from a systematic review on the incidence and prevalence of cancer in MS, analysing 38 studies conducted in the period 1953-2010 (Marrie et al, 2015); cervical, breast, and digestive cancers were the most frequent malignancies reported in this work. Increased incidence of other organ-specific cancers was described, such as bladder cancer, in a population-based study in Ontario (Marrie et al, 2021), and melanoma skin cancer in a Danish study (Norgaard et al, 2019). The increased risk of different organ-specific cancers detected across studies suggests a relevant contribution to this risk of genetic and environmental co-factors specific for the study population; this suggests that caution should be adopted in generalizing such observations to pwMS residing in different geographical areas and with different genetic background.…”

Perspectives on urological care in multiple sclerosis patients

“…In a matched cohort study, the incidence rates and mortality rates for bladder cancer were higher in the MS cohort than in the matched cohort, consistent with some, but not all prior studies. The increased risk of bladder cancer in the MS cohort may reflect the more frequent presence of risk factors such as recurrent UTIs or the use of chronic indwelling catheters secondary to the neurogenic bladder (65).…”