Monday, 30 March 2015

Comorbidities: MS and cancer risk

MSers may have a higher incidence of developing bladder cancer. #MSBlog #MSResearch


"The following meta-analysis is the next in a recently published series of papers by Ruth-Ann Marrie and colleagues. It suggests MSers have a higher incidence of urinary tract cancers and meningiomas than the general population. The higher incidence of meningiomas is likely to be explained by ascertainment bias; MSers are more likely to have MRI scans and hence small incidental meningiomas are more likely to be detected. Why would urinary tract and in particular bladder cancers be higher? This is probably due to the high incidence of bladder problems in MS and the resultant recurrent or chronic urinary tract infections. Bacterial metabolism and inflammation in the bladder drive genetic mutations in the cells lining the bladder, which increases the risk of getting bladder cancers. In addition, at one time cyclophosphamide, a chemotherapeutic drug, was commonly used to treat MS. One of the active breakdown products or metabolites of cyclophosphamide is concentrated and excreted in the urine. This metabolite is carcinogenic and may explain some of the historical risk of bladder cancer at a population level."
"In my slide presentation below I make a suggestion that MSers treated with interferon-beta who develop long-lasting neutralizing antibodies to IFN-beta may also be at increased risk of developing cancers. IFN-beta is know to have anticancer effects and if NABs neutralises your own IFNbeta this may increase your risks of developing some cancers. Several years ago I asked all the three companies manufacturing IFN-beta as a treatment for MS to set-up a surveillance study to look at this question and other in relation to the potential long term effects of NABs. Unfortunately, none of the companies were interested doing this and by inference none were interested in knowing about the longterm impact of NABs. At the time I was surprised by this, but as I have gotten older and more cynical I am not surprised. IFNbeta is a multi-billion dollar a year franchise; any focus on long term safety would jeopardise that franchise. The good news is the Danish MS Registry is addressing this question and we should get an answer from them soon. The one caveat is there may be too few MSers in Denmark with NABs and too few cancers to give a definitive answer. In my presentation I also highlight the possible risk of NABs to bone health, that is in MSers and children born to mother with NABs, and on the risk of infections." 


"In summary, we need new and larger studies to assess whether or not MSers are at increased risk of getting cancer. The meta-analysis of published studies does not provide sufficient information."

Marrie et al. A systematic review of the incidence and prevalence of cancer in multiple sclerosis. Mult Scler. 2015 Mar;21(3):294-304. Epub 2014 Dec 22.

BACKGROUND: Studies of cancer incidence and prevalence in MS have produced conflicting results.

OBJECTIVE: To estimate the incidence and prevalence of cancer in MSers and review the quality of included studies.

METHODS: We searched the PUBMED, SCOPUS, Web of Knowledge, and EMBASE databases, conference proceedings, and reference lists of all articles retrieved. Abstracts were screened for relevance by two reviewers. Data from included articles were captured using a standardized form, and the abstraction was verified by a second reviewer. We assessed quality of the included studies. We quantitatively assessed studies using the I 2 statistic, and conducted meta-analyses for population-based studies.

RESULTS: We identified 38 studies. Estimates for incidence and prevalence varied substantially for most cancers. In population-based studies, cervical, breast, and digestive cancers had the highest incidence. The risk of meningiomas and urinary system cancers appeared higher than expected, while the risks of pancreatic, ovarian, prostate and testicular cancer were lower than expected.

Conclusion: The complexity of understanding cancer risk in MS is augmented by inconsistencies in study design, and the relative paucity of age, sex and ethnicity-specific risk estimates from which the strong impact of age on the incidence of cancers can be assessed.

"The following are my slides from the recent NMSS-ECTRIMS comorbidity meeting in Toronto."


"The following is the programme from last week's NMSS-ECTRIMS comorbidity meeting in Toronto; you may need to see the programme to put my talk into the correct context."



CoI: multiple

2 comments:

  1. I've often asked the question regarding my cancers and the connection with MS. I ask as I feel it could be due to a compromised immune system. Maybe when I ask, I should mention, that I've not been on DMTs or Interferons, because I feel like a bit of a foll, never had an answer.

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  2. Thanks advertising post removed. We cant see the embedded links until they are posted and so some things slip through

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