Possible association between pernicious anaemia and leukaemia: A prospective study of 1,625 patients with a note on the very high incidence of stomach cancer

Abstract

Several patients with pernicious anaemia have been reported to have developed leukaemia and the suggestion has been made that the two diseases are aetiologically associated.Sixteen hundred and twenty-five patients attending eight pernicious anaemia clinics were, therefore, followed from the time of their first attendance to I January, 1964 In most of the patients who developed both diseases the Ieukaemia was of the myeloid type ( I 5 out of a total of 21 reportedpreviously or in this series).In 1957, Blackburn reported three patients evidence, however, it was difficult t o decide who had developed leukaemia while under whether the association of the two diseases in treatment for pernicious anaemia and noted the same patients was due to chance, or whether seven similar events in the literature. On this it reflected an aetiological connection. Further

Pernicious anaemia and cancer risk in Denmark

“…In this cohort study of patients with PA we found a two-fold increase in the risk for stomach cancer in accordance with previous estimates (Blackburn et al, 1968;Brinton et al, 1989;Hsing et al, 1993). Our finding of an excess of cancer of the buccal cavity and pharynx is consistent with findings in the two large US and Swedish studies (Brinton et al, 1989;Hsing et al, 1993).…”

“…Several previous studies have documented an increased incidence of stomach cancer in patients with pernicious anaemia (PA) (Blackburn et al, 1968;Elsborg and Mosbech, 1979;Borch et al, 1988;Brinton et al, 1989;Hsing et al, 1993). An increase in the risk for other upper gastrointestinal cancers such as buccal cavity and pharynx (Brinton et al, 1989;Hsing et al, 1993) and oesophagus (Hsing et al, 1993) has also been reported, as well as increases for other digestive organ cancers [liver, biliary tract and pancreas (Hsing et al, 1993)], though these cancers have been investigated less extensively among PA patients than stomach cancer.…”

Cancer risk following pernicious anaemia

“…Although the 2.1% prevalence of pernicious anaemia among 917 gastric cancer patients was not significantly higher than that of 1.4% among age-matched controls, the difference was significant when analysis was restricted to patients diagnosed with pernicious anaemia more than 5 years before cancer diagnosis. In addition, a follow-up study of 1,625 pernicious anaemia patients (Blackburn et al, 1968) found that, after excluding deaths in early periods when selective inclusion of patients may have occurred, the 29 deaths from stomach cancer significantly exceeded the 7.3 deaths expected, resulting in a SIR of 4.0 -a figure only slightly higher than the risk of 3.2 found in the present study.…”

“…In addition, when examined as a group, the risk of oral and pharyngeal cancers increased with the interval since diagnosis of pernicious anaemia, reaching a significant risk of 2-fold with 6 or more years of latency. The major risk factors for oral and pharyngeal cancers are smoking and drinking (Blot et al, 1988). However, since the risks for lung cancer were low in our survey (SIR=0.8), it appeared that smoking may be less prevalent than in the general population.…”

“…It has been estimated that the risk of stomach cancer is increased 3-to 6-fold in pernicious anaemia patients (Berkson et al, 1956;Elsborg & Mosbech, 1979;Eriksson et al, 1981;Hitchcock et al, 1955;Kaplan & Rigler, 1945;Zamcheck et al, 1955), but such figures derive from autopsy studies or prevalence surveys which may have inherent sources of bias. In one prospective study (Blackburn et al, 1968), deaths due to stomach cancer were elevated 4-fold, with evidence of continued elevations 10 or more years after initial treatment, but comparable information on cancer incidence was unavailable.…”