Increasing cancer risk over calendar year in people with multiple sclerosis: a case-control study

J Neurol. 2020 Oct 21. doi: 10.1007/s00415-020-10170-5. Online ahead of print.

Abstract

Background: Data on cancer prevalence and incidence in multiple sclerosis (MS) patients are controversial. This study is aimed at estimating cancer risk in MS patients.

Methods: Nested case-control study using data collected between 01/01/1987 and 28/02/2016 from the United Kingdom Clinical Practice Research Datalink. Cancer diagnoses after first MS code (index date) was counted in 10,204 MS patients and 39,448 controls matched by sex, age, general practitioner, and registration year. Cancer rates were compared using multivariable Cox regression models. Ethics approval was not required.

Results: Cancer was reported in 433 (4.41%) MS patients and 2014 (5.31%) controls after index date. Cancer risk was associated with gender (HR for female = 0.88, 95% CI = 0.81-0.96, p = 0.004), age at index date (HR = 1.06, 95% CI = 1.06-1.07, p < 0.001), and index year (HR = 1.01, 95% CI = 1.00-1.02, p = 0.016), but not with MS status (HR = 0.95, 95% CI = 0.86-1.05, p = 0.323). A significant interaction between MS status and index year was found (HR = 1.02, 95% CI = 1.00-1.04, p = 0.022). Cancer risk was positively associated with index year among MS patients (HR = 1.03, 95% CI = 1.01-1.05; p = 0.010), but not controls (HR = 1.01, 95% CI = 0.99-1.02; p = 0.144). MS patients compared to controls had no increased risk for any specific cancer type.

Conclusions: Overall cancer risk was similar in multiple sclerosis patients and matched controls. The frequency of cancer diagnoses has increased over time among MS patients but not in controls.

Keywords: CNS; Cancer; Demyelinating autoimmune diseases; Multiple sclerosis; Neoplasms; Risk.