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New article in Cancer journal linking CFS to some froms of cancer

Discussion in 'General ME/CFS News' started by Gamboa, Jun 1, 2012.

  1. Gamboa

    Gamboa Senior Member

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    Here is the article from the journal Cancer.

    Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults
    1. Cindy M. Chang PhD, MPH1,
    2. Joan L. Warren PhD2,
    3. Eric A. Engels MD, MPH1,*
    Article first published online: 30 MAY 2012
    DOI: 10.1002/cncr.27612
    Copyright © 2012 American Cancer Society
    Issue
    [​IMG]
    Cancer

    Early View (Online Version of Record published before inclusion in an issue)

    1. This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. We thank Winnie Ricker (Information Management Services, Rockville, MD) for assistance with database management.
    Abstract

    BACKGROUND:

    The cause of chronic fatigue syndrome (CFS) is unknown but is thought to be associated with immune abnormalities or infection. Because cancer can arise from similar conditions, associations between CFS and cancer were examined in a population-based case-control study among the US elderly.
    METHODS:

    Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare registry data, approximately 1.2 million cancer cases and 100,000 controls (age range, 66-99 years; 1992-2005) were evaluated. CFS was identified in the period more than 1 year prior to selection, using linked Medicare claims. Unconditional logistic regression was used to estimate the odds ratios (ORs) comparing the CFS prevalence in cases and controls, adjusting for age, sex, and selection year. All statistical tests were 2-sided.
    RESULTS:

    CFS was present in 0.5% of cancer cases overall and 0.5% of controls. CFS was associated with an increased risk of non-Hodgkin lymphoma (NHL) (OR = 1.29, 95% confidence interval [CI] = 1.16-1.43, P = 1.7 × 10−6). Among NHL subtypes, CFS was associated with diffuse large B cell lymphoma (OR = 1.34, 95% CI = 1.12-1.61), marginal zone lymphoma (OR = 1.88, 95% CI = 1.38-2.57), and B cell NHL not otherwise specified (OR = 1.51, 95% CI = 1.03-2.23). CFS associations with NHL overall and NHL subtypes remained elevated after excluding patients with medical conditions related to CFS or NHL, such as autoimmune conditions. CFS was also associated, although not after multiple comparison adjustment, with cancers of the pancreas (OR = 1.25, 95% CI = 1.07-1.47), kidney (OR = 1.27, 95% CI = 1.07-1.49), breast (OR = 0.85, 95% CI = 0.74-0.98), and oral cavity and pharynx (OR = 0.70, 95% CI = 0.49-1.00).
    CONCLUSIONS:

    Chronic immune activation or an infection associated with CFS may play a role in explaining the increased risk of NHL. Cancer 2012. © 2012 American Cancer Society.
     
    taniaaust1 likes this.
  2. taniaaust1

    taniaaust1 Senior Member

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    Sth Australia
    Its great to see an actual cancer study which comes up with a result in which Ive heard ME experts talk about in the past (non-Hodgkins lymphoma).
     
  3. oceanblue

    oceanblue Senior Member

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    This looks a little suspect to me: can't see why they are using only95% confidence intervals when looking at so many different cancers (ie so many different comparisons). And those Odds Ratios are tiny (eg NHL OR 1.29 [95% CI 1.16-1.43]). Add in that the CFS cases are not rigorously diagnosed (ie from Medicare claims)then sadly I don't think this tells us much. Sorry to pour cold water on this.
     
  4. Esther12

    Esther12 Senior Member

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    Seems a bit of a leap from their data to their conclusions!

    I agree with OB that this doesn't show us much.
     
  5. Valentijn

    Valentijn Activity Level: 3

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    1 in every 200 people have CFS? Maybe with a very broad definition of CFS.
     
  6. Snow Leopard

    Snow Leopard Senior Member

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    This appears to be an NIH based study. The data might not be as great as we'd like (limited to ICD code entries). but the way the results are being presented in this way shows you these authors are treating CFS seriously.

    Here is a quote from the paper:

    This figure is in the ball park of most epidemiological studies I have seen, from Asia to Europe, to South America...
    Keep in mind that this is an elderly population too.
     
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  7. Esther12

    Esther12 Senior Member

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    Yeah... politically there are things which make me feel hopeful, but I try to stay critical regardless of that, perhaps even in a slightly unfair manner.

    I really don't know anything about immune activation etc in CFS, or the known implications of differing rates of certain types of cancer. If this study is building upon other compelling work, then it's conclusion might be more justified. I probably should have kept quiet!
     
  8. ixchelkali

    ixchelkali Senior Member

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    That wouldn't be 1 in 200 people have CFS, it would be 1 in 200 people who have filed Medicare claims have CFS. You would expect the percentage of sick people who have ME/CFS to be higher than the percentage of the general population.
     
    alex3619 likes this.
  9. WillowJ

    WillowJ Senior Member

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    it seems really odd that they used an elderly population as control. cancer is increased in elderly in any case. It's almost like they were trying not to find it in ME/CFS.
     
  10. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    I think the cancer patients were elderly. The controls needed to be of similar age.
     
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  11. WillowJ

    WillowJ Senior Member

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    that's what I was going to say... maybe everybody is elderly.... I'm not sure from the abstract but that could be...
     
  12. Snow Leopard

    Snow Leopard Senior Member

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    You might be able to guess from the title though. ;)
     
    WillowJ likes this.
  13. Merry

    Merry Senior Member

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    Additional information in this ProHealth article:

    http://www.prohealth.com/library/showarticle.cfm?libid=17017

    ME/CFS strongly associated with later-life non-Hodgkins lymphoma: Medical Statistics

    Article:
    Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults
    – Source: Cancer, May 30, 2012

    by Cindy M Chang, Joan L Warren, Eric A Engels

    [Note: an OR (odds ratio) of 1.0 would signify no difference in average risk between CFS & non-CFS populations. An OR of 1.88, for example, would indicate an 88% greater average risk for the CFS population. OR of 1.51 would be 51% greater average risk, and so on.]

    Abstract:
    Summary: Using US linked registry data on 1.2 million cancer cases and 100,000 population-based controls, risk was evaluated for a wide range of cancer types following a diagnosis of chronic fatigue syndrome. A strongly significant elevated risk was found for non-Hodgkin lymphoma associated with chronic fatigue syndrome, and in particular, associations for 2 specified non-Hodgkin lymphoma subtypes (diffuse large B cell lymphoma and marginal zone lymphoma).

    Background: The cause of chronic fatigue syndrome (CFS) is unknown but is thought to be associated with immune abnormalities or infection.

    Because cancer can arise from similar conditions, associations between CFS and cancer were examined in a population-based case-control study among the US elderly.

    Methods: Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare registry data, approximately 1.2 million cancer cases and 100,000 controls (age range, 66-99 years; 1992-2005) were evaluated.

    CFS was identified in the period more than 1 year prior to selection, using linked Medicare claims. Unconditional logistic regression was used to estimate the odds ratios (ORs) comparing the CFS prevalence in cases and controls, adjusting for age, sex, and selection year. All statistical tests were 2-sided.

    Results:

    • CFS was present in 0.5% of cancer cases overall and 0.5% of controls [1 in 200 people in Medicare database].

    • CFS was associated with an increased risk of non-Hodgkin lymphoma (NHL) (OR = 1.29, 95% confidence interval [CI] = 1.16-1.43, P = 1.7 × 10−6th).

    • Among non-Hodgkin lymphoma subtypes, CFS was associated with diffuse large B cell lymphoma (OR = 1.34, 95% CI = 1.12-1.61), marginal zone lymphoma (OR = 1.88, 95% CI = 1.38-2.57), and B cell NHL not otherwise specified (OR = 1.51, 95% CI = 1.03-2.23).

    CFS associations with non-Hodgkin lymphoma overall and NHL subtypes remained elevated after excluding patients with medical conditions related to CFS or non-Hodgkin lymphoma, such as autoimmune conditions.

    CFS was also associated, although not after multiple comparison adjustment, with cancers of the pancreas (OR = 1.25, 95% CI = 1.07-1.47), kidney (OR = 1.27, 95% CI = 1.07-1.49), breast (OR = 0.85, 95% CI = 0.74-0.98), and oral cavity and pharynx (OR = 0.70, 95% CI = 0.49-1.00).

    Conclusions: Chronic immune activation or an infection associated with CFS may play a role in explaining the increased risk of non-Hodgkin lymphoma.

    Source:Cancer, May 30, 2012. DOI: 10.1002/cncr.27612, by Chang CM, Warren JL, Engels EA. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland; Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA. [Email: Eric A. Engels MD, MPH (engelse@exchange.nih.gov)] National Cancer Institute Senior Investigator Eric Engels, MD, MPH, specializes in study of immunosuppression, infection and inflammation in cancer; Cindy Chang, PhD, MPH, specializes in non-Hodgkin lymphoma research; and Joan L Warren, PhD, specializes in Medicare data analysis for cancer-related research.

    The authors note: This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. We thank Winnie Ricker (Information Management Services, Rockville, MD) for assistance with database management.
     
  14. Cort

    Cort Phoenix Rising Founder

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    actually some data has suggested CFS is linked Non Hodgkins Lymphoma for 2 decades but the data has been sparse and the subject hardly studied. A Univ of Nevada at Reno researcher presented data at the Reno IACFS/ME conference that appeared to indicate a connection but the study was never published...However good this study is it is intriguing that this particular cancer popped up again..(what are the odds of that?); maybe it will give an impetus to get that other study published.
     
  15. alex3619

    alex3619 Senior Member

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    In a study in elderly people, it was found that those with CFS had an increased rate of various lymphomas. Because of the paywall I am not sure of the selection criteria.

    Full abstract here:
    http://onlinelibrary.wiley.com/doi/10.1002/cncr.27612/abstract

    (my bolding)

    RESULTS:

    CFS was present in 0.5% of cancer cases overall and 0.5% of controls. CFS was associated with an increased risk of non-Hodgkin lymphoma (NHL) (OR = 1.29, 95% confidence interval [CI] = 1.16-1.43, P = 1.7 × 10−6). Among NHL subtypes, CFS was associated with diffuse large B cell lymphoma (OR = 1.34, 95% CI = 1.12-1.61), marginal zone lymphoma (OR = 1.88, 95% CI = 1.38-2.57), and B cell NHL not otherwise specified (OR = 1.51, 95% CI = 1.03-2.23). CFS associations with NHL overall and NHL subtypes remained elevated after excluding patients with medical conditions related to CFS or NHL, such as autoimmune conditions.
     
    Merry likes this.
  16. Tally

    Tally Senior Member

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    I wonder if that might be because we get more tests done on us using X-rays than average person. I got 2 CTs and countless X-rays until the doctors accepted my ME as diagnosis.
     
  17. SilverbladeTE

    SilverbladeTE Senior Member

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    radiation damage is less of an issue the older you get
    Radiation damage to DNA in children has greatly increased risks, by about a thousand fold, iirc versus an "old" person.


    Alex
    for the mentally challenged, *cough, me!* :p, what is the actual % above norm of finding NonHodgkins Lymphoma in ME patients from this study?
     
  18. Holmsey

    Holmsey Senior Member

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    Don't know much about x-ray source radiation, I do know that low level raditation actually stimulates the immune system among others in a beneficial way, the Victorians were drinking the stuff, some names from that time still survive such as Radox, now manufacturing bath products.

    Anyway to the point, isn't it more likely that the constant swelling/pain of lymph glands plays a role, I'm likely to have swelling or pain in one or another set on an at least twice monthly basis.

    If I ignore the suggestion that I'm simply imagining this symptom then clearly something is 'happening' to my lymph system that it doesn't like, only other time I've had such symptoms has been during acute infection.

    Anyone know if the psyc's have ever done such a patient review to see if there's a link between 'any' psychatric disorder and Non Hodgkins Lymphoma, for instance could there be a link betwee unremitting stress and NHL?
     
  19. Tally

    Tally Senior Member

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    I know but I am in my early twenties. I know chances are minimal, but (unless I misunderstood) the increased risk in people with CFS was also minimal.
     
  20. alex3619

    alex3619 Senior Member

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    Hi SilverbladeTE, if i had the full paper I might be able to answer that.

    However, in running a search to find that I discovered this is a second thread on this topic:

    http://forums.phoenixrising.me/inde...al-linking-cfs-to-some-froms-of-cancer.17740/

    Somehow I missed the first thread, doh.

    The reason I posted this was the increased discussion recently of polyclonal B cell expansion, including the mention of it by Lipkin. I think its a lymphoma risk factor.

    Here is another discussion elsewhere:

    http://www.mecfsforums.com/index.php?topic=12422.0

    Note in particular this link:

    http://chronicfatigue.about.com/b/2012/06/08/cancer-risk-linked-to-chronic-fatigue-syndrome.htm

    In this it says: "Through use of medical records and Medicare claims, researchers discovered the risk of non-Hodgkin lymphoma (NHL), late in life, was 29 times greater in those with ME/CFS. The risk of other forms of cancer did not appear to be elevated."

    It was pointed out in the comments though that the real risk is still uncertain, this is only a place to start.

    Based on this http://seer.cancer.gov/statfacts/html/nhl.html it can be seen that the incidence of lymphoma is 19.6 per 100,000 though there are subgroups. Allowing for a tentative 29 fold increase, the incidence of lymphoma in CFS can be approximated to 568 per 100,000. That is about 1 in 176, though the figure may not hold in a younger group or between sexes.

    Using an age adjusted death rate of 6.6 per 100,000, an estimation of deaths in CFS might be 191 per 100,000. Again, this is only tentative.


    Bye, Alex
     

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